Operational definitions for conceptual frameworks

Nursing is an art, a humanistic science, and an intellectual discipline of informed caring (Swanson, 1993). Informed caring represents the essence of nursing by reflecting caring as a nurturing way of relating to others toward whom one has a professional commitment and by unifying the diverse knowledge, skills, and processes of nursing into an integrated whole. In the context of “informed caring for the well-being of others” (Swanson, 1993, p. 352), nursing exists as a profession that directs its diverse, integrated elements in a person-centered manner toward assisting person to achieve health, quality of life, well-being, and/or quality of death.

Person represents the client—the central focus of informed caring—and may be an individual, family, community, population, or system. Person includes spiritual, cultural, social, psychological, and bio-physical dimensions. These dimensions are brought by person into any interaction. Person is not only at the center of care, but is also recognized “as the source of control and full partner in providing compassionate and coordinated care.”(QSEN, 2011).

Environment is local and global and includes, but is not limited to, physical, psychological, cultural, financial, regulatory, technological, and political elements. Environment directly affects a person’s health, health-related behaviors, and overall well-being. The nurse’s concept of environment provides the structure for understanding the impact of multidimensional external elements on person. To facilitate an environment that is conducive to optimum health, the nurse must understand how individual and family relationships, values and beliefs about one’s culture and resources available within the home and community shape environment as well as one’s actual physical living space. The culture of the practice environment—whether inpatient, outpatient, or in-home—is complex and creates the need for interprofessional collaboration and collaboration with person in order to optimize management of each person’s needs within a cost-effective framework. Through the educational experience, it is essential for the nurse to grasp how the dynamic interaction of environmental factors affects health outcomes.

The word “health” derives from the word “whole.” Health is reflective of the multidimensional nature of persons. The harmonious interconnectedness of the dimensions of person is necessary to achieve health and well-being. Health and well-being are defined by persons with those definitions being influenced by the constructs of the society and culture in which they live. All persons have the right to access health care and to participate fully in decisions affecting their health, quality of life, and/or quality of death. Persons have significant impact on their health through their life choices. Supporting the optimal health of persons includes disease prevention and promoting healthy lifestyle behaviors, regardless of clinical diagnosis.

A philosophical view in which nursing practice supports the well-being of persons through the promotion of self-advocacy as much as possible and through indirect advocacy by the nurse when required. As a patient advocate, a nurse provides services that support and/or empower the client to support quality of life, promotes patients’ rights, and ensures the person’s needs and preferences are the primary concern of health professionals. Being an advocate is a significant role for nurses in any setting. Nurse advocates take other leadership roles to educate, improve healthcare delivery, ensure safety and cost-effectiveness of care, have a voice in healthcare policy decisions, and promote nursing by maintaining a positive image of the profession.

Competency can have several meanings. A nurse who performs at an expected level is demonstrating competence. Competence can be described as the ability to act effectively using critical thinking, efficient problem-solving, and ethical decision-making. Competency can also reflect a measurable level of performance that integrates knowledge, psychomotor, communication, diagnostic and problem-solving skills in clinical practice. The ability to perform at an expected level is the responsibility of the individual nurse and can be achieved through the process of lifelong learning.

Evidence-Based Practice
A problem-solving approach that combines best evidence from current research, the clinician’s expertise, and the preferences of each person. As part of a leadership role, the nurse serves as a role model and mentor for staff making evidence-based decisions. Incorporating EBP into nursing care allows the nurse to take ownership of his or her practice by serving as a strong patient advocate and transforming health care through quality improvement.

Informed Caring
The result of applying empirical, aesthetic, ethical, and personal understanding to aspects of a given health interaction with the goals of fostering quality of life and well-being while maintaining belief in, knowing, and intervening on behalf of and enabling the person.

Interprofessional Teams
Healthcare teams include person, the nurse, and other healthcare professionals that cooperate, collaborate, communicate, and integrate care which ensures that healthcare delivery is high-quality, person-centered, continuous, and reliable. The nurse is an integral member of the interprofessional team which strives to establish collegial relationships aimed at improving patient health outcomes through shared respect and trust. The nurse has an awareness of the unique discipline-specific knowledge which can impact patient care. Communication among interprofessional teams includes collaborating to identify shared goals, communicating clear role expectations, and engaging in a flexible decision-making process through the establishment of open communication patterns and leadership.

Liberal Arts Education
Liberal arts education prepares students to understand the world better and to become a contributing member of society, whether local or global. Academic studies cover the arts, humanities, languages, social sciences, and physical sciences. It is this broader understanding of the human condition that is integrated into nursing practice.

Person-centered care
Health care that establishes a partnership among healthcare professionals and clients (or person) to ensure that decisions respect clients’ wants, needs, and preferences and that clients have the education and support they need to make decisions and participate in self-care. It also means considering clients’ cultural traditions, personal values, family situations, social circumstances and lifestyles. Four key attributes of person-centered care are: (1) “whole person” care, (2) coordination and communication, (3) client support and empowerment, and (4) ready access to healthcare services.

Nursing Informatics
Nursing informatics is a broad field where nursing science merges with technology to enhance the quality of nursing practice through improved communication and overall efficiency. Nurses utilize the concepts of information management to identify, collect, record, analyze, and disseminate data pertinent to safe, quality nursing care. The nurse in advanced practice may have responsibilities for education, research, project management from development through implementation, and systems testing and evaluation. These responsibilities serve to support nursing in direct and indirect care delivery as well as to support the health of people through information processing and communication.

Professional Service
Service is action performed for the benefit of another. Professional service involves specialized education, knowledge, judgment and skill; it is the nature of the action, rather than the person, that identifies service as professional. The nurse will exhibit compassion in all professional relationships and respect the dignity, worth and uniqueness of every person.

Professional Values
Nursing is a caring profession. The values associated with caring include, but are not limited to, compassion, empathy, altruism, integrity, respecting human dignity, and social justice. These core values inform practice and the actions of the nurse.

Quality improvement (QI)
QI is the continuous process of increasing the safety of healthcare delivery, improving the quality of healthcare services, and attaining desired health outcomes. From a clinical perspective, this means avoiding preventable injuries, reducing medical errors, improving practice flow, using evidence-based research in practice, and utilizing resources appropriately. From a systems perspective, this means creating an organizational climate where excellence is valued and practiced. Organizational commitments to quality can include policies, procedures, tools, systems, and performance measures that support a safe and high-quality healthcare delivery system.

Transformational Leadership
Leadership is described as transformational when there is a positive change in thinking and movement toward a desired state through creating a vision, goal setting, encouragement and direction. A transformational leader shapes and fosters a unified purpose and continuous quality improvement through open, constructive communication; critical thinking; affirmation of others’ beliefs and values; empowerment of individuals; and consistent demonstration of responsibility and accountability.

Ways of Knowing
The body of knowledge that a nurse uses in nursing practice is derived from ways of thinking that have fundamental patterns. Understanding these patterns involves attention to what kind of knowing is of value to nursing. Carper (1978) identified four patterns within nursing knowledge:
(1) Empirical knowing is concerned with the science of nursing and includes general laws and theoretical frameworks from nursing and related disciplines. The nurse draws from a broad knowledge base to use critical thinking for decision-making and relies on evidence to guide practice.
(2) Aesthetic knowing is the art of nursing that is a fluid and dynamic approach to understanding and attaching meaning in a situation. Aesthetic knowing allows the nurse to perceive and empathize with the situations of persons, foster compassion, actively listen, and nurture. Nursing as an art is based on caring and respect for human dignity.
(3) Personal knowing is concerned with interactions and relationships between nurse and person. Personal knowing is a way of employing “therapeutic use of self” by viewing the person as a human being, rather than an object or a diagnosis, and understanding the person in his world.
(4) Ethical knowing is concerned with the “right action” within a situation and the moral obligations inherent in that situation. Ethical knowing goes beyond knowing the norms or ethical code of nursing by recognizing that all voluntary actions are subject to the judgment of right and wrong.