Domain 1: Knowledge for Nursing Practice - Core Assessment, Planning, and Care Components
Domain 1 of nursing practice encompasses comprehensive patient assessment, systematic care planning with prioritized interventions, and evidence-based care delivery that directly addresses patient needs through structured evaluation and documentation.
Comprehensive Patient Assessment Framework
Holistic assessment forms the foundation of all nursing care and must capture multiple dimensions of patient status to identify real needs and guide intervention priorities. 1, 2
Essential Assessment Components
Medical and Clinical Assessment:
- Complete medical history including current/prior diagnoses, surgical procedures, left ventricular function assessment, comorbidities (peripheral arterial disease, cerebrovascular disease, pulmonary disease, kidney disease, diabetes, musculoskeletal/neuromuscular disorders, depression), current symptoms, and medication review with dosing, frequency, and compliance patterns 1
- Physical examination of cardiopulmonary systems including pulse rate/regularity, blood pressure, heart/lung auscultation, lower extremity edema assessment, arterial pulse palpation, post-procedure wound sites, orthopedic/neuromuscular status, and cognitive function 1
- Diagnostic testing including resting 12-lead ECG and health-related quality of life assessments 1
Psychosocial and Functional Assessment:
- Pain assessment and sensory deficit identification 1
- Recognition of drug side effects and medication-related complications 1
- Psychosocial needs evaluation and spiritual aspects of care 1
- Educational barriers and learning preferences 1
- Family dynamics and support systems 1
Assessment as Foundation for Priority Setting
Priority setting requires ordering nursing problems using concepts of urgency and importance to establish preferential sequencing of nursing actions. 3 This skill is critical because deficits in priority setting can have serious consequences for patients 3. Assessment must view patients holistically to identify their real needs, as this forms the basis of the entire care plan 2.
Key factors influencing priority setting include:
- Nurse expertise level and clinical judgment 3
- Patient's current condition and acuity 3
- Available resources and staffing 3
- Ward organization and care delivery models 3
- Nurse-patient relationship quality 3
Systematic Care Planning and Documentation
Treatment plans must document patient assessment information that reflects current status and guides development of prioritized goals with specific intervention strategies for risk reduction. 4
Core Planning Elements
Goal Development and Prioritization:
- Short-term goals (weeks to months) within core care components that guide intervention strategies 1, 4
- Priority ordering based on life-threatening situations addressed sequentially 5
- Risk reduction strategies with clearly defined intervention approaches 4
Documentation Requirements:
- Patient assessment data reflecting current status 1, 4
- Prioritized treatment goals 1, 4
- Intervention strategies for each identified need 1, 4
- Medication management details ensuring appropriate dosing per clinical guidelines 4
- Discharge/follow-up plans reflecting progress toward goals and guiding long-term prevention 1, 4
Collaborative Communication
Treatment and follow-up plans must be communicated interactively with patients and appropriate family members/domestic partners in collaboration with the primary healthcare provider. 1, 4 This collaborative approach ensures:
- Shared understanding of care goals 1
- Family involvement in care decisions 1
- Coordination across the interprofessional team 1
- Alignment with patient preferences and values 1
Evidence-Based Care Delivery
Nursing care delivery requires expert health assessment skills, organized time/task management, situation analysis capabilities, and problem-solving in priority order. 1
Essential Practice Competencies
Clinical Skills and Knowledge:
- Hands-on technical skills in area of practice 1
- Understanding of illness pathophysiology and associated complications 1
- Teaching/learning principles for patient/family education 1
- Nutrition education capabilities 1
Communication and Coordination:
- Interpersonal communication skills with patients/families, staff, colleagues, and physicians 1
- Appropriate referrals to other agency services and community resources 1
- Nursing diagnosis formulation and measurable goal development 1
Patient-Centered Care Approach
Care activities must be planned and implemented based on treatment goals, viewing the patient as part of a family and community while encouraging patient/family independence. 1 This requires:
- Clear direction provided to patients during visits 1
- Realistic and practical approaches to patient situations 1
- Demonstrated empathy without imposing personal values 1
- Recognition and management of family concerns related to health problems 1
- Balanced attention to psychosocial and physical care 1
Quality Improvement and Evaluation
Nursing leadership must facilitate delegation and oversight of care tasks, initiation and evaluation of care plans, and assessment of their effectiveness. 1 Registered nurses should function as mentors and supervisors for other care personnel 1.
Continuous Assessment and Adaptation
Audit of nursing care prioritization and targeted training based on identified weaknesses significantly improves nurses' skills to prioritize patient care needs and enhances quality of care delivery. 5 This systematic approach to quality improvement ensures:
- Regular evaluation of priority-setting accuracy 5
- Identification of skill deficits requiring education 5
- Measurable improvement in care quality 5
Implementation Strategy Considerations
Multi-component implementation strategies are most effective for nursing guideline adoption, with educational meetings, educational materials, and educational outreach visits being the most frequently used approaches. 1 These strategies should include: