Advanced Practice Nursing Curricula

Health Delivery System Competencies

Program Outcome #4: Evaluate the design, implementation, and outcomes of strategies developed to meet healthcare needs (MSN Essentials).

Nursing leaders are in a good position to facilitate the evaluation and implementation of healthcare system designs by drawing on evidence-based practice instead of intuitive perceptions, but the use of this approach is fairly recent (Harris, 2009). The curricular offerings provided by the MSN program served to emphasize this need and demonstrated how integrating evidence-based practice into system design can help improve patient care outcomes.

MSN Essential IV: Translating and Integrating Scholarship into Practice Recognize that the master's-prepared nurse applies research outcomes within the practice setting, resolves practice problems, works as a change agent, and disseminates results.

In their capacity as healthcare leaders, advanced practice nurses have a fundamental responsibility to identify constraints to effective patient care and develop appropriate solutions in response. As Forest and Kleiner (2011) point out, "Nurses are change agents and nursing theories reflect this" (p. 255). The curricular offerings provided by the MSN program demonstrated the importance of these issues as well as how important findings can be communicated to other healthcare professionals.

Applies knowledge of organizational practices and complex systems to improve health care delivery.

Until fairly recently, the healthcare delivery system used in the West was largely based on an acute care model wherein patients presented with various symptoms and signs which were diagnosed by a doctor and an appropriate remedy provided (Bernstein, 2008). By very sharp contrast, the healthcare delivery system that developed by the turn of the 21st century introduced various alternative approaches to healthcare delivery, including expanding managed care as well as implementing disease-management and case-management programs (Bernstein, 2008). In sum, the curricular offerings provided by the MSN program served to provide a better understanding of these changes and how they affect patient care (The essentials of master's education in nursing, 2011).

Effects health care change using broad-based skills including negotiating, consensus-building, and partnering.

The MSN program provided a foundation that can facilitate the forging of evidence-based healthcare among clinicians and allied health professionals (Kalb & O'Connor, 2015). Because there are so many diverse interests involved, negotiating optimal approaches for healthcare delivery requires tact and a recognition that there are a number of factors that must be taken into account in formulating appropriate changes to the healthcare delivery system (Kalb & O'Connor, 2015). The curricular offerings provided by the MSN program highlighted this need and served to emphasize the challenges that are involved in effecting change within any healthcare organization. For instance, according to the American Association of Colleges of Nursing, the curricular offerings provided by the MSN program "provide graduates with a fuller understanding of the discipline of nursing in order to engage in higher level practice and leadership in a variety of settings and commit to lifelong learning" (The essentials of master's education in nursing, 2011, p. 4).

Minimizes risk to patients and providers at the individual and systems level.

Healthcare settings can be extremely dangerous places because of the traumatic exigencies of the potentially life-threatening situations in which patients present. Patients and family members are already distraught and the potential for violence is always present, especially in tertiary healthcare settings (Stichler, 2011). As Stichler points out, "Patients come to hospitals in their most vulnerable state -- often in pain, usually fearful, and always feeling a bit out of place. A hospital can be a dangerous place for patients because its unfamiliar environment contrasts with home" (p. 73). The curricular offerings provided by the MSN program served to highlight these risks and how healthcare providers can minimize these risk to the maximum extent possible.

Facilitates the development of health care systems that address the needs of culturally diverse populations, providers, and other stakeholders.

One of the more challenging aspects of delivering high-quality healthcare services is the diversity of the populations being served. For instance, Ndiwane and Bonner (2009) report that, "The ethnic composition of people in this country is becoming increasingly diverse. These trends testify to the great need for advanced practice nurses who are sensitive to and competent to care for culturally diverse populations" (p. 119). Moreover, the composition of the healthcare provider population is also becoming more diverse, making the need for cross-cultural competencies greater than ever before. In this regard, Utley-Smith (2009) emphasizes that, "Nurses must be able to change, use critical thinking and problem-solving skills, and communicate effectively with multidisciplinary team members" (p. 167). In response to this need, the curricular offerings provided by the MSN program served to highlight the need for cross-cultural competencies that can help overcome these constraints to high-quality healthcare delivery.

Evaluates the impact of health care delivery on patients, providers, other stakeholders, and the environment.

While patient safety and welfare remain the top priority in any healthcare setting, it is also important to take the impact of the healthcare delivery model on all stakeholders, including the general public and the natural environment (Scott & Struder, 2003). As Scott and Struder emphasize, "Our role as healthcare leaders is not simply to perform better, but to do so while being increasingly accountable to our consumers" (p. 41). The curricular offerings provided by the MSN program served to highlight the importance of these issues and focused greater attention on the need to take these concerns into account when developing healthcare delivery systems and policies.

Analyzes organizational structure, functions and resources to improve the delivery of care.