Curriculum follows directly from the Yale School of Nursing’s mission and philosophy. The aims and assumptions of the School state:
The master’s curriculum is designed to offer students an opportunity to become prepared as advanced practitioners in selected health care specialties so that they may assume roles as clinicians, scholars, and leaders and ultimately improve health care for all people. Advanced Practice Nurses are committed to the delivery and the study of high-quality, evidence-based clinical care and work to help shape health care systems. The program of study in the School is viewed as preparation for graduates’ continuing activity in a variety of leadership roles.
Advanced Nursing Practice
Nursing involves an alliance with the patient or health care system using a holistic and contextual perspective. This statement is further substantiated by a direct quote:
…to assist the individual, sick or well, with those activities contributing to health or its recovery (or to a peaceful death) that [the patient] would perform unaided if [the patient] had the necessary strength, will or knowledge. And to do this in such a way as to help [the patient] gain independence as rapidly as possible.
—V. Henderson, The Nature of Nursing (Philadelphia: Macmillan, 1963)
Advanced Nursing Practice is defined as specialization in an area of practice and builds upon mastery of depth and breadth of specific knowledge. Practicing at the advanced level also involves the identification of signs/symptoms/behaviors that indicate vulnerability and the selection of interventions to promote health and prevent illness, disability, and complications. Nurses in advanced practice integrate knowledge, scholarship, management, leadership, and consultation into their role and function in collaboration with other members of the health care team.
Knowledge supporting advanced practice nursing is organized into three constructs: clinical practice, scholarship, and leadership.
Clinical practice includes the assessment, management, and coordination of health care needs of individuals, families, groups, communities, and/or populations. This care occurs within bio-psychosocial, cultural, political, environmental, and economic contexts.
Clinical practice requires that clinicians foster, develop, and sustain effective patient-provider relationships within the context of complex organizational and health care delivery systems. Excellent clinical practice is based on current and relevant evidence-based data and entails the systematic collection of diverse forms of information, sound analytical reasoning, strong interpersonal and leadership skills, knowledge of organizational and systems behavior, and proficiency in translating knowledge into practice and policy. The ultimate goal of clinical practice is to enable patients to attain the best possible quality of life by integrating principles of health promotion and disease prevention into their lifestyles and fostering an effective patient-provider relationship. Clinical practice includes clinicians’ ability to coordinate patient care, resources, and services among providers and to provide patients with the information needed to attain optimum health outcomes.
Scholarship forms the underpinning and context for advanced practice nursing. Scholarship encompasses the iterative process of generating and testing theories, applying them in practice settings, and revising theories based on data. This intellectual process involves familiarity with knowledge of current and cutting-edge science from nursing and other health-related disciplines, critical analysis, hypothesis formation and testing, and consideration of alternative theories. In clinical practice, scholarship includes assessment, data gathering, hypothesis generation, and use of clinical data for evaluation.
Scholarship involves systematic evaluation of the rationale for health-related decision-making, critical analysis of health-related issues and policies, and the process of describing, explaining, and predicting phenomena of relevance to human health, health care environments, and nursing. Examples of relevant phenomena include, but are not limited to, patterns of human behavior and the contexts in which it occurs, physiological and pathophysiological processes, and health care systems, ethical concerns, and policy. Knowledge is generated through empirical, aesthetic, personal, and ethical ways of knowing. Ongoing critical evaluation of the state of the science and questioning of available information, as well as personal clinical wisdom, are critical components of scholarly inquiry.
Scholarly activity is the hallmark of graduate education in nursing and provides the basis for delivery of evidence-based best nursing practices. Scholarship is an essential organizing construct for the curriculum and is evident in the strong emphasis on using empirical, personal, aesthetic, and ethical knowledge. Development of scholarly skills and use of knowledge derived from these skills are addressed in clinical and didactic courses.
Leadership is essential for creating change within a society, organization, or health care system. Ultimately, leadership is about the capacity for vision and the wise use of power, authority, managerial skills, and influence to enable others to accomplish and sustain change. Change is an important concept based in knowledge of group process, organizational and systems theory, and leadership strategies. Influence comes in part from knowledge of the health care system’s structure and process, inter- and intra-professional issues, and public and private sector policies as they affect health care services. Influence also arises from interpersonal competence and knowledge of human relations theories. Leadership is necessary at all levels of the health care organization, including at the level of patient care, where it is seen in autonomy and accountability of practice, grounded in specialized practice knowledge. Leadership is fundamental to providing equitable health care for all people.
Thus, the three major constructs—clinical practice, scholarly inquiry, and leadership—reinforce each other, true to the nature of knowledge in advanced nursing practice, and provide the organizing framework for the master’s objectives and outcomes.