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THE AMERICAN HOLISTIC NURSESCREDENTIALING CORPORATION

ITEM-WRITER’S HANDBOOKFOR AHNCC NURSES EXAMINATION

AHNCC, 2002, 2008, 2011, 2012, 2016, 2017, 2019Not to be reprinted without

Permission of AHNCC

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Table of Contents

Welcome letter to Item-writer……………………………………………………… 3Item Submission Guidelines & Form ……………………………………..…….. 4Interactive Letter of Agreement……………………………………………………. 7Appendix A

AHNCC General Guidelines for Examination Item Writing……………… 8Guidelines and Information on item writing………………………… 9

Appendix BStandards and Competencies for the Holistic Nurse………….…............... 15

•Basic Competencies ……………………………………………. 15•Advanced Competencies………………………………………… 21

Appendix CHolistic Nursing Core Values and Competencies by Level of Certification. 27

Appendix DStandards and Competencies for the Nurse Coach..................................... 31Core Values and Competencies by Level of Certification.......................... 38

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THE AMERICAN HOLISTIC NURSESCERTIICATION CORPORATION

Dear Colleague,

Thank you for your interest in the work of AHNCC. We appreciate your assistance in the matter of item-writing for our examinations. At no time will your name be associated with any item, although you can request CEs, required for Recertification, by completing the Request for Continuing Education Units at the end of this Handbook. Enclosed in this handbook you will find several documents, listed according to their purposes. See below:

The AHNCC Item Submission Form and Letter of Agreement Needed to Submit Your Items (pp. 4-7).

1. This is the form you will use to write and submit your items (pp.4-7). 2. AHNCC’S Item Writer’s Letter of Agreement is attached to the end of the Submission Form

(p.8). It is necessary that we maintain security at all time. Therefore, we ask that you carefully read this Letter of Agreement before you sign it. This letter must be signed and submitted at the same time as you submit the items. An electronic signature (i.e. /name typed/) will be accepted. Your items will not be considered for inclusion in our examinations, nor will you earn CEs for item submission without a signed Letter of Agreement.

Appendix A: Guidelines (Information to Help You Develop Your Items, pp. 8-14).1. AHNCC’s General Guidelines For Writing Examination Items includes information about

the format, preparation, and submission of your items.2. The Item Development Guidelines provides general guidelines for item preparation. This

set of guidelines was developed by the testing management company.Appendix B and C: Holistic Nursing Standards and Competencies (To Guide Your Item Writing Process, pp. 15-30).

1. There are two sets of Holistic Nursing standards and related competencies shown here. a) The first set (pp. 15-20) list the standards and competencies for Basic Holistic Nursing. b) The second set (pp. 21-26) list the standards and competencies for Advanced Holistic Nursing. Competencies 44-52 are for the APHN-BC® examination only.

2. Appendix C follows (pp 27-30) these documents showing linkages among the competencies and AHNA Core Values, leveled by certification type, i.e. Basic Holistic Nursing: HN, HNB; Advanced Holistic Nursing: AHN, APHN (APRN); and Nurse Coach: NC-BC®. You can refer to these to level your items by type of examination (i.e. Basic, Advanced, or Advanced Practice).

Appendix D: Nurse Coach Standards and Competencies; and Standards, Competencies and Core Values (pp. 31-39).

Thank you for your assistance in the ongoing work of the Certification Processes of Holistic Nurses. If you have any questions, please do not hesitate to contact us for clarification ([email protected]).

Peace and blessings to you and yours, Margaret Erickson, PhD, APRN, AHN-BC®

Executive Director AHNCC

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AHNCC’S ITEM SUBMISSION GUIDELINES

Please use this online form to submit your items. Items can be typed DIRECTLY into this form.

First, indicate the examination that you are addressing. Simply click in the box behind the name of the examination.

Next determine which standard you want to write items to test. The Standards for the Holistic Nursing examinations can be found in Appendix B (pp. 15-30) and those for Nurse Coaching are in Appendix D (pp.31-38). The competencies are listed immediately below each standard. Select the standard that you want to write items to test (click in the box), and then select the competency (write the number associated with the competency on the line). For example, the first standard for Basic Holistic Nursing (Assessment) and the first two competencies is shown below.

1. ASSESSMENT: The holistic, registered nurse collects comprehensive data pertinent to the healthcare consumer’s health and or the situation. The Holistic Nurse:

1. Centers self before interacting with client.2. Elicits client story (to reveal context and complexity of the human health experience).

If you choose to write an item to test assessment skill and knowledge, click in the Standard 1 box, select which of the list of competencies (1-27) that your item will test, and write that number on the blank line.

Write your stem and potential answers in the blank lines. Type in the gray areas; as you type the space will expand. Do not worry about formatting, just keep working!

Thank you for your help in this essential aspect of the Certification Process

START HERE. TELL US WHICH EXAMINATION YOU ARE WRITING ITEMS TO TEST.The following items are written for the HN-BC® Examination ; HNB-BC® Examination ; AHN-BC® Examination ; APHN-BC® Examination ; or the Nurse Coach Examination .

USE THIS FORM TO TYPE IN YOUR QUESTIONS AND ANSWERS.

Item 1. Standard: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Related Competency:

.Write your Stem here : (write response #1 here) (write response #2 here) (write response #3 here) (write response #4 here) Write reference #1 here: Write reference #2 here:

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Item 2. Standard: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Related Competency:


Item 3. Standard: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Related Competency:


Item 4. Standard: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Related Competency:


Item 5. Standard: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Related Competency:


Item 6. Standard: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Related Competency:


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Item 7. Standard: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Related Competency:


Item 8. Standard: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Related Competency:


Item 9. Standard: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Related Competency:


Item 10. Standard: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Related Competency:


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THE AMERICAN HOLISTIC NURSES CREDENTIALING CORPORATION

ITEM-WRITER’S LETTER OF AGREEMENT

I, understand that I am submitting items for the AHNCC Certification Examinations based on the precepts of Holistic Nursing. I understand that the Basic Level Examinations are for the HN-BC® (i.e. the Holistic Nurse, Board Certified at the Non-BSN level) and the HNB-BC® (i.e. Baccalaureate in Nursing Holistic Nurse, Board Certified at the BSN level); the Advanced Level Examination is for the AHN-BC®

(i.e. Advanced Holistic Nurse, Board Certified at the Graduate level) and the APHN-BC® (i.e. Advanced Practice Holistic Nurse, Board Certified at the Graduate level); and the NC-BC® is for the Nurse Coach Role, Board Certified Registered Nurse. I also understand that my signature below indicates that I am qualified to write items for the specific examination that I have indicated on the Item Submission Form and below.

I understand that the items I submit are for the sole use of AHNCC certification examinations. I also understand that once submitted, the items become the property of the American Holistic Nurses Credentialing Corporation (AHNCC) and that there are to be absolutely no copies of any items I submit nor any records or documents of item content maintained in my possession after they are submitted for use. Furthermore, I understand that I am to maintain security of all items submitted by promising that I will never discuss, write, talk about, share or communicate in any other way the content of the items. Finally, I understand that I am to submit the one and only copy of these items to AHNCC at both [email protected] and [email protected] and then destroy this form, removing it from my computer

Please use the following Checklist to assure compliance of the above agreement. Place your initials in each blank line to indicate your agreement.

My items were developed using references as indicated on my submission form All items are typed using Times Font Size 12. The stem of each item asks a single question and is written in positive form (i.e. no negatives in the stem, such as the word not). All items have four response options, are multiple choice, and one correct answer only. No responses are written as All of the above, or A and b above. I have identified the correct answer by using a key such as * or #. References are written in APA format. All copies of these items will be destroyed as soon as I receive a receipt from AHNCC for my work. No paper copies, digital copies, hard-drive copies, or other types of copies are retained by myself or anyone to my knowledge. If I do not hear from AHNCC within 2 days, I will contact them to ensure my email arrived. I understand that I am not to disclose anything about about these items and never to use my items for other purposes. The information listed below, followed by my signature, indicates that I am qualified to write items for the certification examination: HN-BC® Examination ; HNB-BC® Examination ; AHN-BC® Examination ; APHN-BC® Examination ; or the Nurse Coach Examination .

Level of Practice Practice setting Focus of practice Highest educational degree Geographical location (city, state) AHNCC Certification #

I sign this agreement with complete willingness to participate according to the standards and criteria stated above.

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mailto:[email protected]


Signature Credentials Date

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APPEDIX A

GENERAL GUIDELINES FOR WRITING EXAMINATION ITEMSTHE AMERICAN HOLISTIC NURSESCREDENTIALING CORPORATION

Overview

AHNCC’s Specific Directions for item preparation are listed below. It is important that you read these carefully; they describe the format required for item submission. After that, you will find seven (7) pages of general information prepared by the testing management company. The testing management company administers our examinations and runs statistical analysis to assess for reliability. Their guidelines will help you write good items. We recommend that you read the entire set of guidelines before you start writing. If you have questions, please do not hesitate to contact us at [email protected].

AHNCC Specific Directions for Submission of Items

A. Select the Standard that you want to address, consider your expertise. Review the Standards and related Competencies in Appendix B to help you decide.

B. Select the competency you wish to address. You will find them directly under each Standard.

C Format: Write single stem items with 4 possible answers. ONLY one answer can be correct. Alternative answers might be similar to the correct answer, but must be clearly wrong. No double negatives can be included in the responses. All questions must be brief and unambiguous. All items require two references. References can be any published, recognized, and circulated book, article or other publication that addresses the art and/or science of the Holistic Nursing as described in the AHNA/ANA Holistic Scope and Standards of Practice (AHNA/ANA, 2007), pages 8-17.

D Preparation of Items: The AHNCC Item Submission Form is interactive, so you should be able to type directly onto the form. Remember, include at least two references immediately below the item; use APA format. For example: Frisch, N.C., Dossey, B.M., Guzzetta, C.E., & Quinn, J.A. (2000). American Holistic nurses standards of practice: guidelines for caring and healing. Gaithersburg, MD: Aspen. Repeat this process until you have finished. To receive CE credit, you must submit at least 5 items. If you wish to write more, we’ll be happy to receive them.

E Submission of Items: When you are finished writing items, SAVE the entire file in a safe, and secured location that can be easily retrieved. Complete, sign, and date the Letter of Agreement included in this packet. You can use an electronic signature, i.e. /your name/. Send the entire packet to [email protected] and copy [email protected]. AHNCC will send you a receipt for your files. Retain your receipt to document that you have earned CE credits for your work. AHNCC will not be able to send you a copy; it will be your responsibility.

F Protecting security of the items. Once you have received your receipt, be sure that you have destroyed any and all documents that you have used to create these items. This includes any copies you’ve made, notes, and all other documents used in the drafting of said items.

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Appendix A: Guidelines (Continued)

PROFESSIONAL TESTING CORPORATION’SITEM DEVELOPERS GUIDE

1350 BROADWAY 17th FLOOR NEW YORK, NEW YORK 10018 (212)356-0660

Copyright © 2002. All rights reserved.

Professional Testing Corporation.Printed in U.S.A.

This guide has been prepared to assist individuals in writing test items, particularly for use in credentialing types of examinations. It presents the reasons for using objective tests and, specifically, multiple-choice items (questions). It also describes the characteristics of good items and suggests approaches to developing them.

WHY USE OBJECTIVE TESTS?

An objective examination is one that can be scored on the basis of a predetermined scoring key. Especially when a large group of candidates is to be tested, as in a credentialing program, a machine-scored, objective

examination has numerous advantages.It is efficient and convenient to administer, since all candidates receive the same questions, the same answer

choices, the same type of answer document, and the same directions. It eliminates the influence of extraneous variables, such as candidates’ handwriting, spelling, and grammar, that could interfere with the

objective and valid appraisal of the abilities the questions were designed to assess. It permits rapid and reliable scoring and reporting of results. It facilitates the collection of statistical data about the examination.

WHY USE ONLY ONE TYPE OF TEST ITEM?

Measurement professionals recommend using as small a number of different item types as possible within a single examination, and preferably only one. They base their recommendation on the following premises:Administration of the examination is simplified when only one type of item is used. This is especially important when there is a time limit for completing the examination. Each different type of item in the examination involves the uses of testing time and space for directions to candidates to explain how to respond to the different item types. From a psychometric standpoint, the time and space could be used more effectively to improve the reliability and validity of the measurement by asking more questions of the one type.When candidates must change to a different item type, some may fail to follow directions, leading to errors in measurement.Although the inclusion of a variety of item types might be thought to add interest to the examination process, it is equally possible to derive interest from the content and quality of the items, rather than from their form, and a variety of item types may become a source of distraction rather than of interest.

WHY USE MULTIPLE-CHOICE ITEMS?

There are four principal types of objective test items: completion, matching, true-false, and multiple-choice. If only one type of objective test item is to be used, the flexible and adaptable multiple-choice item is the logical choice. A creative item writer can devise multiple-choice items that can be used to measure any of the knowledges, skills, and abilities that can be measured with paper-and-pencil tests. Content that can be tested with a completion item can just as easily be tested with a multiple-choice question by giving a candidate four

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choices from which to complete the statement rather than having them write out an answer. Matching items can also be adapted into multiple-choice items, and a multiple-choice item can be produced from materials that might have been appropriate for use in four true-false questions, using one true statement as the correct option and three false ones as distracters. (Distracters are sometimes referred to as foils, incorrect options, or wrong answers.)

Multiple-choice items are suitable for use in evaluating the attainment of all types of learning objectives, from the simplest recall of knowledge through comprehension, interpretation, application, analysis, and synthesis, up to and including evaluation. Except for creativity and writing ability, most educational objectives, including understanding and problem-solving, can be assessed by carefully developed multiple-choice items. The usefulness of multiple-choice items is limited principally by the skill of the item writer.

WRITING ITEMS

The task of the item writer is the most difficult and the most critical in the entire process of test development. Without good items, it is impossible to have a good examination. The item writer must be familiar with the content to be covered by the examination, choose topics for the items that are to be written, present each question and its right answer clearly and succinctly, and devise plausible but incorrect options to serve as distracters.

HOW SHOULD THE ITEM WRITER BEGIN?

Before starting to write any items, the item writer should become familiar with the outline of content for the examination. The outline defines the content that the examination is to cover, and the emphasis that is to be given to each part of the outline. The item writer must also consider what is expected of the minimally competent candidate who will take the examination in order to determine the appropriate level of difficulty for the items.

Ideas for items may come from many different sources. The item writer’s own experience in the work situation is likely to suggest problems and situations around which items can be written. Keeping in mind that the examination will be administered as part of a procedure for the promotion of the public in terms of safety and quality of service, the item writer can often recall functions, roles, concepts, and abilities that are essential components of knowledge for the entry level or minimally competent candidate. In situations involving safety problems, items can be written to determine whether candidates know what should be done. Other sources of inspiration might include situations in which a less-than-competent person could cause harm, or where an improper sequence or lack of knowledge could lead to an undesirable outcome.Reading materials, both texts and references, can also suggest topics for items, but it is important to keep in mind that the best items rarely measure rote memory; rather, they attempt to evaluate a candidate’s ability to apply principles and demonstrate insights and understanding. Sentences taken from printed materials have not been known to yield good test items.

Having selected a topic on which to write an item, the item writer should consider whether the topic involves knowledge or the application of knowledge that is important in relation to those who will take the examination. The item writer should also make sure that there is general agreement about the topic among knowledgeable people in the subject-matter area, and that there are some misconceptions about the topic. Once that is done, the item writer is ready to start drafting the item.

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WHAT ARE THE COMPONENTS OF A MULTIPLE-CHOICE ITEM?

Each multiple-choice item is composed of a stem followed by four options – one correct option and three distracters.

Example Stem: Who invented the light bulb?

Answers: 1. Thomas Alva Edison* (Correct answer) 2. Benjamin Franklin3. Alexander Graham Bell

4. Leonardo da Vinci

The stem of a multiple-choice item may be presented in question form, as in the previous example, or as an incomplete statement, as shown in the example below.

Example Stem: The light bulb was invented by Answers:

1. Thomas Alva Edison (Correct answer)2. Benjamin Franklin3. Alexander Graham Bell.4. Leonardo da Vinci.

It is sometimes easier for beginners to produce good items if they use the question form, since each of the options must then be an answer to the question asked in the stem. Certain types of content may also lend themselves more readily to one form than the other. Other than those two considerations, there is no psychometric reason for choosing between the question form and the incomplete statement.

WHAT ARE THE CHARACTERISTICS OF A GOOD ITEM STEM?

A good stem presents a problem situation clearly. Knowledgeable candidates should be able to look at the stem and produce the desired response before referring to the option. Consider the following examples:

1) An elevated white blood cell count is a)_a sign of infectionb) gravely dangerous.c) normal.d) any count over 20,000.

2) An elevated white blood cell count is most often symptomatic of a) infection.b) diabetes.c) high blood pressure.d) respiratory insufficiency.

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In the first item, the stem does not pose a problem; it fails to provide candidates with a frame of reference for answering the question. In the better item, the candidates know that they are looking for a condition that can that has an elevated white blood cell count as a symptom. This suggests that the correct option will be in the form of a disease or a pathological state.

A good item stem is stated positively rather than negatively. The first example below is a negatively stated item. Notice that it makes the reader consider two things: reversing their thought pattern of selecting the correct answer, and which is correct. The next example focuses only on selecting the correct answer.

1) Which of the following is NOT a city in Californiaa) Boise*b) Sacramentoc) Los Angelesd) San Francisco

2) In which state is the city of Boise located?a) Idahob) Iowac) New Jerseyd) California

At times, a negative stem is unavoidable, as in a safety related question where it is important for candidates to know what NOT to do in a certain situation. In those cases, the negative term (e.g. NOT, EXCEPT, LEAST, CONTRAINDICATED, etc.) should be capitalized and presented in bold face or underlined to call attention to it.

A good item stem avoids the use of the pronouns “it”, “he”, “she”, and “you”. In the case of “it”, “he”, and “she”, the candidate may be uncertain about the referent. Questions that ask “What would you do?” can have no single right answer, since individual candidates could justify their individual responses.

A good item stem is presented as simply as possible, including only information that is necessary to understand the problem. See the examples below. Note that the first question, the reader has to sort through irrelevant information. Try to avoid this when writing examination questions.

Mr. Watson is a 73-year-old widower who has suffered from headaches for several years. His wife died four years ago, as the result of a stroke. They had two children, both now grown and living in other parts of the country. Mr. Watson believes that his headaches may be due to high blood pressure, but tests to date have not confirmed his suspicions. In an effort to establish the cause of Mr. Watson’s headaches, what is the first procedure that should be initiated?

What should be the first procedure to be initiated to diagnose the probable cause of chronic headaches in an otherwise healthy 73-year-old man?

A good item stem includes all words that would have to be repeated in each option, put them in the stem instead. Examples

Ice forms on water when: a) The temperature falls below 32 degrees F at sea level*

b) The temperature falls below 24 degrees F at sea level.13/41

c) The temperature falls below 12 degrees F at sea level.d) The temperature falls below 0 degrees F at sea level.

At sea level, ice forms on water when the temperature falls below:a) 32 degrees F.b) 24 degrees F.c) 12 degrees F.d) 0 degrees F.

A good item stem specifies the authority or standard upon which the correct option is based, if the item calls for a judgment.

The diet of Americans provides vitamins and minerals in amounts that area) Adequate for normal nutritionb) Inadequate for normal nutrition.c) In excess of normal requirements.d) Variable in relation to individual requirements.

According to the American Medical Association, the diet of the average American provides vitamins and minerals in amounts that are

a) Adequate for normal nutrition.b) Inadequate for normal nutrition.c) In excess of normal requirements.d) Variable in relation to individual requirements.

A good item stem poses a problem to which the correct answer is not likely to change over time.

Who was the President of the United States last year?a) Bill Clintonb) Ronald Reaganc) Jimmy Carterd) Gerald Ford

Who was the President of the United States in 1995? a) Bill Clintonb) Ronald Reaganc) Jimmy Carterd) Gerald Ford

A good item stem focuses on important learning objectives and avoids testing trivia. Testing for knowledge of facts and principles is not trivial, since such evaluation constitutes an appropriate objective.Examples are shown below.

The initials NRA stand fora) National Recovery Actb) National Rifle Associationc) Northeast Regional Accreditationd) Nebraska Recreational Administration.

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What legislation, passed by Congress during the Great Depression, was later found to be unconstitutional?

a) National Recovery Actb) National Rifle Associationc) Northeast Regional Accreditationd) Nebraska Recreational Administration.

The first item illustrates more than one defect. The item is testing at a trivial level, and any of the four options would be correct. The second item requires candidates to apply more knowledge in selecting the correct option.

WHAT ARE THE CHARACTERISTICS OF GOOD OPTIONS?

Correct options are unquestionably correct, and distracters are unquestionably wrong. All four options are grammatically related to the stem. If the stem asks a question, each of the four options provides a plausible answer to the question. If the stem is an incomplete statement, each option serves to complete the statement. The four options are homogeneous in terms of structure as well as content. Difficulty is most likely to occur in achieving this objective when the item stem has not presented a clearly defined question or problem. The correct option is similar in length to the distracters. If the item contains distracters that are short and imprecise with a correct option that is long and fully qualified, candidates will quickly recognize and reject the distracters. If the correct option includes one or more key words that appear in the stem, the distracters also contain those key words. Absolute terms have been avoided. In poorly constructed test items, options containing “all”, “none”, “always” and “never” are likely to be found in distracters, while less definite terms such as “generally” and “often” are likely to be used in correct options. Candidates will quickly recognize the absolute terms in the distracters and reject those distracters. Options are mutually exclusive. If two options have the same meaning, and only one answer is to be selected, candidates will realize that both options must be incorrect and recognize them as distracters. The intended correct answer includes no incorrect information that might force candidates to choose between ignoring the incorrect information and selecting some other option. “None of the above” has been avoided, if at all possible. If it has been used, then the following additional rules have also been observed. The correct option is completely and precisely correct. None of the above” has been used in several items, and it has sometimes been the correct option, but not always. None of the above” has not been used as a fourth option when there are only three logical options, such as “more than”, “less than”, and “equal to”. (In such instances, it is best to discard or revise the item.)“All of the above” has not been used as an option. The reason for this rule is that if each of the options is a correct response, than any of them would have to be considered as correct in scoring them. Since the examination directions specify that there is a single correct answer to each item, the use of “All of the above” would violate that specification.

HOW CAN AN ITEM WRITER FEEL CONFIDENT THAT AN ITEM IS USABLE?

Combine the two or three correct responses into one option, and try to develop new options containing multiple components to replace the distracters. If one of the correct options is better than the others in terms of precision or terminology, discard the others and try to replace them or leave their places blank for colleagues to suggest replacement. While negative questions have certain undesirable characteristics, some questions can best be presented in that way. The item writer may choose to ask “Which of the following is NOT ...” Such questions should only be asked when it is important for candidates to know that something is NOT correct.

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APPENDIX BHOLISTIC NURSING, BASIC PRACTICE STANDARDS AND COMPETENCIES

1. ASSESSMENT: The holistic, registered nurse collects comprehensive data pertinent to the healthcare consumer’s health and or the situation. The Holistic Nurse:

1. Centers self before interacting with client.2. Elicits client story (to reveal context and complexity of the human health

experience).3. Prioritizes data collection activities based on client’s immediate needs,

condition, and/or situation.4. Collects data relevant to the holistic paradigm in a systematic and ongoing

process.5. Uses holistic nursing concepts to guide data collection.6. Uses holistic nursing theories to guide data collection.7. Uses scientific (empirical) knowing when gathering and validating data.8. Uses esthetic knowing when gathering and validating data.9. Uses ethical knowing when gathering and validating data.10. Uses own personal knowing when gathering data.11. Uses sociopolitical knowing when gathering and validating data.12. Uses unknowing when gathering data.13. Uses reflective knowing when gathering and validating data.14. Assesses client’s perceptions and meaning of signs and symptoms, health,

illness, sickness, and well-being.15. Assesses client’s understanding of the diagnostic procedures, the diagnosis,

and treatment plan including integrative health practices.16. Assesses client’s use of and preferences for conventional and integrative

health strategies.17. Assesses client’s learning needs and readiness to learn.18. Assesses client values, beliefs, and cultural practices.19. Assesses client’s lifestyle patterns and risk behaviors.20. Assesses client’s physical, mind, body, spiritual dimensions and their

interactions.21. Assesses client’s comfort status and related resources.22. Assesses client’s coping status and related resources.23. Assesses cultural and environmental factors effecting client’s wellbeing.24. Assesses significant others’ perceptions of the situation.25. Assesses interactions between the client and significant others.26. Assesses client’s strengths, challenges, and available internal and external

resources.27. Documents relationship among diagnoses, expected outcomes, and

evidence-based, holistic care plan in a secure and retrievable manner.

2. DIAGNOSIS: The holistic, registered nurse analyzes data to determine the diagnosis or the issues. The Holistic Nurse:

28. Uses holistic nursing theories to interpret meaning and to identify relationships among the data collected.

29. Synthesizes data/information to identify patterns.16/41

30. Analyzes pattern(s) of data collected to derive diagnoses.31. Validates diagnosis in partnership with client(s).

3. OUTCOMES IDENTIFICATION: The holistic, registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation. The Holistic Nurse:

32. Partners with client to formulate realistic outcomes that emphasize holistic health and wellbeing.

33. Considers own expertise when defining outcomes.34. Facilitates client’s understanding that there is a potential of the outcomes

evolving over time.35. Uses holistic nursing theory to formulate outcomes.

4. PLANNING: The holistic, registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes. The Holistic Nurse:

36. Clarifies and validates client’s understanding of the plan.37. Facilitates client and significant others to explore holistic strategies and

related resources needed to address each of the diagnoses and the expected outcomes.

38. Integrates spiritually-based interventions in care plan as appropriate.39. Partners with client and significant others (as appropriate) to set a timeline

for the care plan.40. Plans care that links assessment, diagnosis, and potential side effects.41. Uses standardized language and/or recognized terminology to document the holistic plan.

42. Ensures inclusion of client’s values and beliefs in decision-making, holistic care plan, and negotiation of role-responsibilities.

43. Formulates a safe and effective care plan that incorporates appropriate integrative health practices.

5. IMPLEMENTATION: The holistic, registered nurse implements the identified plan. The Holistic Nurse:

44. Integrates current trends, research, and evidence-based interventions specific to the client’s needs, problem, or situation.

45. Uses self as an instrument of healing (e.g. as a conduit of healing energy).46. Uses intentional comfort-touch as appropriate47. Partners with client in decision-making throughout the implementation

process to ensure safe and holistic practice effectiveness.

5a) Coordination of Care: The holistic, registered nurse coordinates care delivery. The Holistic Nurse:

48. Advocates for the client’s self-knowledge as essential information.49. Coordinates implementation of holistic care plan across settings and

caregivers.50. Facilitates client in establishing/maintaining relationships with healthcare

providers that are conducive to healing.

5b) Health teaching and promotion: The holistic, registered nurse 17/41

employs strategies to promote health and a safe environment. The Holistic Nurse:

51. Models ethics and philosophy consistent with holistic nursing’s beliefs.52. Facilitates client’s and significant others to learn that healing is a holistic process.53. Creates safe learning environments.54. Uses teaching-learning methods appropriate to the clients needs and/or situation.55. Seeks ongoing feedback on information provided.56. Facilitates others to access their own inner wisdom.57. Facilitates others to learn about conventional and integrative practices.58. Partners with multiple sources (e.g. clients, advocates, etc.) to create health documents.

6. EVALUATION OF IMPLEMENTED CARE: The holistic, registered nurse evaluates progress toward attainment of outcomes. The Holistic Nurse:

59. Partners with clients and others, as indicated, to evaluate the effectiveness of the plan, and determine factors that contribute to differences between expected and actual holistic outcome.

60. Documents results of the evaluation.61. Uses ongoing evaluation to mutually revise, with persons involved: the plan,

diagnosis, expected outcomes, and implementation.62. Disseminates evaluation results according to laws and regulations.

7. ETHICS: The holistic, registered nurse practices ethically. The Holistic Nurse:

63. Honors uniqueness and inherent worthiness of clients throughout all aspects of the holistic nursing process.

64. Honors the individual as the authority/expert of his/her life experiences.65. Honors and facilitates the natural development of and unfolding of the

client’s human processes, and inherent capacity for self-healing.66. Engages in on-going self-reflection to identify wisdom learned and areas for

self development.67. Values all life experiences as opportunities to find personal meaning and

cultivates self-awareness, self-reflection, and growth.68. Reflects on the effect of one’s cultural and spiritual beliefs, life experiences,

biases, education, and values on his/her professional practice.69. Uses ANA Code of Ethics with Interpretive Statement and AHNA Position

Statement on Holistic Nursing Ethics to guide practice.70. Uses AHNA Core Values to articulate the moral foundation of holistic nursing.71. Practices holistic nursing care in a manner that preserves and protects the

client’s confidentiality autonomy, dignity, rights, values, and beliefs within legal and regulatory parameters.

72. Respects the client’s choices and health trajectory, even when it is incongruent with conventional wisdom/standards.

73. Informs the person of the risks, benefits, and outcomes of holistic healthcare regimes.

74. Assists persons in self-advocacy skill development, which includes making 18/41

informed choices about their care.75. Provides age appropriate holistic care in a culturally and ethnically sensitive

manner.76. Demonstrates a commitment to practice holistic self-care strategies to

manage stress and enhance wellbeing.77. Demonstrates knowledge of the role and referral process of the ethics

committee in the organization.78. Advocates for the holistic wellbeing of the global community with

consideration for the economy, education, and social justice.79. Acts on behalf of vulnerable and/or marginalized individuals or groups who

cannot seek or demand ethical treatment on their own.80. Seeks available resources in formulating holistic, ethical decisions.81. Reports illegal, incompetent, or impaired practices.

8. EDUCATION: The holistic, registered nurse attains knowledge and competence that reflects current nursing practice. The Holistic Nurse:

82. Seeks and acquires knowledge and skills pertinent to the practice of Holistic Nursing.

83. Seeks experiences, formal and informal, to maintain and develop clinical skills, professional knowledge, and personal growth related to holistic nursing.

84. Uses current knowledge, including research findings, to expand clinical practice, professional performance, and role development.

85. Maintains professional records that provide evidence of competency, and life-long learning related to holistic nursing.

9. EVIDENCE-BASED PRACTICE/RESEARCH (EBP): The holistic, registered nurse integratesevidence and research findings into practice. The Holistic Nurse:

86. Uses the best available evidence, including theories and research findings, to guide holistic nursing practice decisions throughout the nursing process.

87. Recognizes that evidence-based practice contains three components: the best evidence, the client’s preferences, and the nurse’s expertise.

88. Participates, actively and ethically, in holistic research activities.89. Participates in the work of the research ethics committee.90. Supports research of others on healing, wholeness, spirituality, and/or other

holistic concepts.

10. QUALITY OF PRACTICE: The holistic, registered nurse contributes to quality nursing practice. The Holistic Nurse:

91. Approaches clients as integrated, adaptive systems, interconnected with all other systems.

92. Acknowledges that holistic health is a multidimensional state of well-being as perceived by the client.

93. Acknowledges health and wellbeing as the desired outcome of holistic nursing practice.

94. Acknowledges self as integral with the healing environment.95. Focuses on facilitating the individual’s growth, holistic health, and wellbeing.

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96. Uses Presence, Intentionality, Compassion, and Authenticity throughout the holistic nursing process.

97. Uses holistic nursing theories to help integrate one’s knowing, doing, and being in practice.

98. Demonstrates quality by documenting the application of the holistic nursing process in a responsible, accountable, and ethical manner.

99. Creates innovative, quality-improvement activities to initiate changes in holistic healthcare.

100. Engages in the practice of self-care as a prerequisite to providing holistic care.

101. Provides age and developmentally appropriate holistic care from infant to elder in a culturally and ethnically sensitive manner.

102. Implements processes to remove/decrease barriers to holistic care.103. Seeks feedback from clients regarding impact and effectiveness of holistic

nursing care.104. Obtains and maintains professional certification in holistic nursing and

other areas of expertise.105. Promotes competency in Holistic Nursing Practice to assure client quality of

care.

11. COMMUNICATION: The holistic, registered nurse communicates effectively in all areas of practice. The Holistic Nurse:

106. Uses communication knowledge and skills (e.g. active listening) to interact effectively within the clients and colleagues worldview.

107. Validates communication with clients and colleagues to ensure constructive, purposeful interactions.

108. Facilitates negotiations of conventional and integrative practices for continuity of care and program planning.

109. Facilitates inter-professional processes that enhance contributions of all members of the health team.

110. Provides information related to the use, efficacy, safety, and indications of integrative health practices to clients and others as indicated.

111. Partners with client and colleagues to enhance healthcare-consumer’s perception of wellbeing.

12. LEADERSHIP: The holistic, registered nurse demonstrates leadership in the professional practice setting and the profession. The Holistic Nurse:

112. Engages in team-work with all healthcare providers.113. Works to create and maintain healthy work environments that supports

holistic healthcare.114. Demonstrates creativity and flexibility during periods of system change.115. Serves in key roles in the work setting by participating on committees,

councils, and administrative activities.116. Promotes advancement of holistic nursing as a profession.117. Has the ability to define a clear vision of holistic nursing practice,

associated goals with implementation and evaluation plans to measure success.

118. Demonstrates energy, excitement, and a passion for quality holistic nursing 20/41

practice.119. Creates an environment that supports holistic nursing in risk-taking

behaviors.120. Proactively promotes innovative ideas aimed at creating an environment

conducive to client holistic health and well-being.121. Supports appropriate balance between work and holistic self-care in the

lives of nurses and other colleagues.

13. COLLABORATION: The holistic, registered nurse collaborates with healthcare consumer, family, and others in the conduct of nursing practice. The Holistic Nurse:

122. Acknowledges and expresses expertise and competency of diverse disciplines.

123. Maintains compassionate and caring relationships with peers and colleagues.

124. Collaborates with inter-professional team to optimize resources needed for holistic care plan.

125. Participates in professional organizations in a membership capacity at local, state, national and international levels to expand promotion of holistic health.

126. Shares holistic nursing knowledge and skills with peers and colleagues at patient-care conferences.

127. Shares holistic nursing knowledge and skills with peers and colleagues at inter-professional team meetings, conferences, and other opportunities.

128. Provides peers with feedback regarding their practice and/or role performance, as it affects the wellbeing of both the peer and their clients, using constructive language and sincere communications.

14. PROFESSIONAL PRACTICE EVALUATION: The holistic, registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations. The Holistic Nurse:

129. Engages in self-evaluation of own professional holistic nursing practice, considering current practice standards, laws, regulations, and rules.

130. Engages in self-evaluation to identify areas of strength, opportunities for professional development with consideration to current laws, regulations, and rules.

131. Seeks informal feedback from clients, and colleagues/peers in respect to professional practice.

132. Seeks formal feedback from clients, colleagues/peers, supervisors, and others.

133. Participates in systematic peer review considering practice standards and guidelines, relevant statutes, rules and regulations.

134. Performs actions necessary to achieve holistic goals identified from evaluation processes.

135. Provides rationale for holistic nursing practice beliefs, decisions, and actions as part of evaluation processes.

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15. RESOURCE UTILIZATION: The holistic, registered nurse utilizes appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible. The Holistic Nurse:

136. Understands the diversity of the global community and associated resources.

137. Incorporates cultural practices that affect the client’s holistic healthcare plan and related outcomes.

138. Evaluates factors such as client resources and circumstances, the safety, cost-benefits, efficiencies, and impact on practice when choosing practice options that result in the same expected outcomes.

139. Facilitates clients in becoming informed consumers of holistic care.140. Identifies and reports discriminatory professional practices.141. Engages in nondiscriminatory holistic nursing practices.142. Assigns or delegates tasks as defined by the state nurse practice acts and

according to the knowledge and skills of the designated care-giver.

16. ENVIRONMENTAL HEALTH: The holistic, registered nurse practices in an environmentally safe and healthy manner. The Holistic Nurse:

143. Acknowledges that the well-being of the ecosystem of the planet is a determining condition for the well-being of holistic human beings.

144. Engages in activities that nurture and enhance our integral relationship with the earth.

145. Proactively works to protect the holistic health and well-being of the ecosystem.

146. Contributes to an environment that is conducive to enhancing the holistic education of healthcare providers.

147. Promotes work environments that support understanding, respect, health, healing, caring wholeness, and harmony.

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APPENDIX B (CONTINUED)HOLISTIC NURSING, ADVANCED PRACTICE STANDARDS AND COMPETENCIES

1. ASSESSMENT: The holistic, registered nurse collects comprehensive data pertinent to the healthcare consumer’s health and or the situation. The Advanced Holistic Nurse:

1. Partners with clients to: explore and validate their story, find meaning embedded in their statements, and explore contextual issues.

2. Assesses, interprets, and synthesizes multiple sources of knowledge to understand the client’s need/problem.

3. Assesses effects of relations and interactions among client, significant others, and/or community on client’s well-being.

4. Assesses client’s sense-of-coherence.5. Uses art interpretation as a source of assessment.6. Interprets diagnostic tests/procedures.7. Assesses relations and interactions among individuals, families, the community, and social

systems on the community’s (and/or society’s) well-being.8. Affirms intuitive insights with client and/or significant others.

2. DIAGNOSIS: The holistic, registered nurse analyzes data to determine the diagnosis or the issues. The Advanced Holistic Nurse:

9. Formulates hypothetical diagnoses regarding bases of client’s needs/ situation or problems derived during interview, examination, and diagnostic processes.

10. Validates diagnosis and expected outcome with client, family/significant other, and other healthcare providers as appropriate.

11. Synthesizes data/information to identify patterns and variances within life context.12. Differentiates clinical findings within normal and/or abnormal variations.

3. OUTCOMES IDENTIFICATION: The holistic, registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation. The Advanced Holistic Nurse:

13. Partners with client and other healthcare providers to formulate inter-professional outcomes, consistent with the diagnoses, client’s perceived needs, circumstances, and resources.

14. Formulates and documents holistic, inter-professional outcomes, derived from the diagnoses, with realistic time frames.

15. Differentiates outcomes that require system-level interventions from those of independent nurse practice activities.

4. PLANNING: The holistic, registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes.The Advanced Holistic Nurse:

16. Partners with client to explore possible strategies using linguistic and symbolic language.17. Considers relations among cost, risks, and benefits of the care plan.18. Evaluates system-wide resources needed to carry out holistic plan.

5. IMPLEMENTATION: The holistic, registered nurse implements the identified plan. The Advance Holistic Nurse:

19. Collaborates with nurses and the inter-professional team to integrate resources for optimal

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holistic plan.20. Maintains a dynamic assessment-diagnosis-outcome-implementation process to ensure

holistic practice effectiveness.21. Uses and/or recommends a range of approaches/therapies, including both conventional

healthcare treatments, and integrative health practices.22. Proposes tests/procedures to the healthcare team, as indicated by client’s

condition/needs/situation.23. Partners with client in decision-making and role negotiations to ensure that the care plan is

safe, efficient, and holistic.

5a) Coordination of care: Advanced Practice24. Integrates and synthesizes inter-professional information needed to prescribe

strategies important to client’s perceived wellbeing, including community support and/or modifications of surroundings.

25. Facilitates staff in developing and maintaining competency in the assessment, diagnostic, planning, and implementation processes.

26. Organizes and coordinates inter-professional holistic care to reflect the priorities of clients and significant others.

27. Coordinates system-wide resources used to provide holistic care.28. Documents coordination of inter-professional holistic care in a manner that is secure

and easily retrieved.29. Refers and follows-up on clients as indicated.

b) Health teaching: Advanced Practice30. Designs and provides health information that is based on cost-effectiveness research

and is appropriate to the client’s unique situation.31. Assists staff in developing and maintaining competency in holistic processes.32. Partners with multiple sources (e.g. clients, advocates, etc.) to create holistic health

documents and health policies.33. Provides clients with appropriate information including side effects and costs of both

conventional and integrative health practices.34. Provides nurses with educational programs that explain/expand holistic nursing.35. Incorporates comparative-effectiveness recommendations when planning and

implementing teaching and counseling processes.36. Evaluates holistic health information acquired from various sources (e.g. books,

brochures, internet, etc.) for accuracy, readability, comprehensibility, quality, and appropriateness for the individual.

37. Evaluates effectiveness of holistic health information provided to help people learn about themselves and their conditions or situations.

38. Partners with clients in various settings to promote health, prevent illness, and provide anticipatory guidance.

c) Consultation: The graduate-level prepared specialty nurse or advanced practice registered nurse provides consultation to influence the identified plan, enhance the abilities of others, and effect change. The Advanced Holistic Nurse:

39. Provides consultation by integrating and synthesizing data from multiple sources of evidence including: clinical data, theoretical frameworks, organizational structures, belief/value systems, and scientific evidence.

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40. Provides inter-professional team members information on holistic principles and practices indicated by client’s situation, worldview, and research findings.

41. Enhance the effectiveness of consultation by involving clients and other stakeholders, negotiating role responsibilities, and using supportive decision-making.

42. Clearly and concisely communicates consultation recommendations to all stakeholders in order to bring about negotiated change.

43. Consults with inter-professional colleagues as needed to enhance holistic plan implementation.

d) Prescriptive Authority: The Advanced Practice Registered Nurse uses prescriptive authority. Procedures, referrals, treatments, and therapies in accordance with state and federal laws and regulations. The APHN Holistic Nurse:

44. Uses advanced knowledge of pharmacology, psychoneuroimmunology, nutritional supplements, herbal and homeopathic remedies, and integrative health practices to plan and prescribe care consistent with client needs/health issues/problem.

45. Synthesizes multiple sources of knowledge/information, including client self-knowledge when prescribing holistic treatment.

46. Prescribes holistic plan care plan co-created by partnering with client.47. Prescribes pharmacologic agents based on current knowledge of pharmacology and

physiology; clinical indicators; age; person’s holistic status/needs; results of diagnostic labs; and the person’s beliefs, values, and choices.

48. Evaluates and analyzes therapeutic effects, possible side-effects, and possible interactions of all prescribed treatments.

49. Provides client with information about cost and expected outcomes of planned treatment and integrative options.

50. Partners with others to create an inter-professional plan that focuses on safe, effective holistic outcomes.

51. Documents collaborative discussions including holistic plan changes, communications, and rationale.

52. Documents referrals, including provisions for continuity of holistic care.

6. EVALUATION: The Advanced Holistic Nurse:53. Partners with client to evaluate the accuracy of the diagnosis, effectiveness of interventions,

change in meaning of experience, and person’s expected outcomes.54. Partners with client to evaluate effectiveness of holistic nursing plan and to adapt care plan

as indicated by evaluation, resources, and/or situation.55. Partners with the client to evaluate the accuracy of the interdisciplinary diagnoses,

expected outcomes, and intervention effectiveness.56. Synthesizes results of evaluations to determine the impact of care and proposed changes in

healthcare processes, and/or systems as indicated and appropriate.

7. ETHICS: The holistic, registered nurse practices ethically. The Advanced Holistic Nurse:57. Participates in inter-professional teams that address ethical risks, benefits, and outcomes.58. Contributes actively and proactively to create an ecosystem that supports well-being of all

life.59. Models expert holistic nursing practice to colleagues, consumers, and inter-professional

team members.

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60. Mentors nurse colleagues in the acquisition and use of holistic nursing knowledge, skills, and ways-of knowing important for each. phase of the nursing process.

61. Uses expert knowledge and skills to influence inter-professional decision-making related to holistic healthcare.

62. Leads the development of continuous improvement of systems that support and/or provide holistic care.

8. EDUCATION: The holistic, registered nurse attains knowledge and competence that reflects current nursing practice. The Advanced Holistic Nurse:

63. Uses current healthcare research findings and other sources to understand national practice standards and trends in holistic nursing.

64. Acquires advanced communication skills and knowledge relevant to the practice of Holistic Nursing.

65. Provides educational programs for nurses and colleagues that explain and expand holistic nursing.

66. Provides professional organization leadership needed to expand provisions of holistic healthcare at local, state, national and international levels.

9. EVIDENCE-BASED PRACTICE/RESEARCH (EBP): The holistic, registered nurse integrates evidence and research findings into practice. The Advanced Holistic Nurse:

67. Facilitates colleagues’ critique of research findings to determine application to holistic nursing practice.

68. Critiques research projects and results to determine appropriateness for application to holistic nursing practice.

69. Uses nursing theory to base and guide research projects.70. Uses research findings in the development of policies, procedures, and practice guidelines

for holistic client care.71. Initiates and maintains a program of research related to holistic nursing.72. Provides guidance and leadership for nurse colleagues (and others as indicated) in the

research process and the use of research findings.73. Advocates for and educates others about the three components of EBP.74. Uses organizational and community resources to formulate multidisciplinary plans of care.75. Develops innovative strategies that consider resource utilization.76. Develops evaluation strategies to demonstrate cost effectiveness, cost-benefits, and

efficiency factors.

10. QUALITY OF PRACTICE: The holistic, registered nurse contributes to quality nursing practice. The Holistic AdvancedHolistic Nurse:

77. Identifies practice situations important for quality monitoring.78. Collects data to monitor quality and effectiveness of holistic nursing practice.79. Uses the results of quality improvement activities to initiate changes in holistic nursing

practice and in the healthcare delivery system.80. Analyzes quality-review data to formulate recommendations for improving holistic nursing

practice.81. Develops indicators to monitor and/or standardize quality and effectiveness of holistic

nursing practice.82. Develops and standardizes Holistic Nursing guidelines, protocols, and practice.

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83. Designs quality improvement initiatives.84. Promotes competency in Holistic Nursing practice to assure quality of care to clients.85. Evaluates the quality-of-care reports to identify research opportunities.

11. COMMUNICATION: The holistic, registered nurse communicates effectively in all areas of practice. The Advanced Holistic Nurse:

86. Engages the healthcare-consumer, family, and team members in planning and implementing holistic care designed to achieve optimal outcomes.

87. Uses advanced knowledge and skills to promote open communication among the inter-professional team members and the client.

88. Uses story-telling to reframe experiences.89. Communicates the holistic care plan, including both conventional and integrative practices,

to the inter-professional team members.90. Partners with others to create an inter-professional plan that focuses on safe, effective

holistic outcomes.91. Documents collaborative discussions (including holistic plan changes, communications, and

rationale).92. Documents referrals, including provisions for continuity of holistic care.

12. LEADERSHIP: The holistic, registered nurse demonstrates leadership in the professional practice setting and the profession.The Advanced Holistic Nurse:

93. Provides leadership for nursing and inter-professional groups aiming to improve holistic healthcare.

94. Promotes advanced holistic nursing practice.95. Models expert holistic nursing practice to colleagues, consumers, and inter-professional

team members.96. Mentors nurse colleagues in the acquisition and use of holistic nursing knowledge, skills,

and ways-of knowing.97. Uses expert communication knowledge and skills to influence inter-professional decision-

making related to holistic client care.98. Formulates recommendations to improve holistic nursing practice.99. Leads the development of continuous improvement of systems that support and/or provide

holistic care.

13. COLLABORATION: The holistic, registered nurse collaborates with healthcare consumer, family, and others in the conduct ofnursing practice. The Advanced Holistic Nurse:

100. Makes referrals and performs follow-up as needed.101. Participates with inter-professional teams that contribute to role development, advanced

holistic nursing practice, and/or holistic healthcare.102. Provides inter-professional educational information on holistic care as indicated.103. Provides professional organization leadership needed to expand provisions of holistic

healthcare at local, state, national and international levels.104. Develops practice environments that recognize, value, and demonstrate holistic

communication as fundamental to care.105. Communicates consultation recommendations, including those that facilitate change.

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14. PROFESSIONAL PRACTICE EVALUATION: The holistic, registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations. The Advanced Holistic Nurse:

106. Engages in formal feedback processes with nursing colleagues to evaluate own holistic practice, knowledge, and skills as they relate to current laws, regulations, and rules.

107. Provides leadership for formal inter-professional processes to evaluate own holistic practice, knowledge, and skills in respect to current practice standards, rules, regulations, and laws.

108. Engages in inter-professional processes to evaluate holistic patient care and organizational issues, given current practice standards and guidelines.

109. Synthesizes results of evaluations to determine the impact of care and propose changes in healthcare processes, and/or systems.

110. Critically examines integrative practices indicated in any treatment plan for their efficacy, safety, and appropriateness.

15. RESOURCE UTILIZATION: The holistic, registered nurse utilizes appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible. The Advanced Holistic Nurse:

111. Assigns or delegates tasks based on holistic needs and conditions of clients, potential for harm, stability of client’s condition, complexity of the task, predictability of the outcome, and professional’s expertise.

112. Uses organizational and community resources to formulate inter-professional care plans.113. Develops innovative strategies that consider resource utilization.114. Develops evaluation strategies to demonstrate cost effectiveness, cost-benefits, and

efficiency factors.

16. ENVIRONMENTAL HEALTH: The holistic, registered nurse practices in an environmentally safe and healthy manner. The Advanced Holistic Nurse:

115. Co-creates partnerships that promote sustainable holistic environmental health policies and conditions.

116. Contributes actively and proactively to create an ecosystem that supports wellbeing of all life.

117. Analyzes the impact of multiple forces (social, political, human, etc.) on the environment.118. Critically evaluates the popular media presentations of environmental health issues.119. Advocates for implementation of holistic environmental principles.120. Supports nurses in advocating for/and implementing holistic environmental principles.121. Works to correct environmental factors that interfere with a healing environment.122. Actively uses self to create a safe, healing environment for clients and caregivers.123. Evaluates the practice environment to identify research opportunities and/or questions,

relevant to holistic nursing.124. Develops practice environments that recognize, value, and demonstrate holistic

communication as fundamental to care.

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APPENDIX CHOLISTIC NURSE CORE VALUES AND RELATED PRACTICE COMPETENCIES, LEVELED BY CERTIFICATION PROGRAM:

HN-BC®, HNB-BC®, AND AHN-BC®

Core Values and related competencies expected at each level of certification are shown below. The expectations are cumulative. That is, the HN-BC® Holistic Nurse is responsible for competencies related to those shown in the first set of cells; HNB-BC® Holistic Nurse is responsible for those shown in the HN-BC® and HNB-BC® cells; and the AHN-BC® is responsible for all cells.

CORE VALUE

1. HOLISTIC PHILOSOPHY, THEORY & ETHICS

2. HOLISTIC EDUCATION & RESEARCH

3. HOLISTIC SELF-CARE

4. HOLISTIC COMMUNICATION, THERAPEUTIC ENVIRONMENT AND CULTURAL DIVERSITY

5. HOLISTIC CARING PROCESS

HN

-BC

® C

ompe

tenc

ies

Demonstrates ability to:

•Articulate the relationship between the caring and healing concepts.

•Discuss and describe coreHolistic Nursing concepts (e.g. Holism,Presence, Intentionality,UnconditionalAcceptance, Caring, Healing, etc., and

•Explain how they are used in one’s personal and professional lives.

Demonstrates desire and ability to advance personal understanding and expertise of Holistic Nursing through continued education

Demonstrates ability to apply concepts of self-care to self and others

Demonstrates ability to create caring environments that are culturally sensitive and conducive to mutual growth and healing in client and nurse

Demonstrates ability to apply:

•Conceptually based holistic nursing to individuals, families, and groups, and

•Selected research findings in the various phases of the caring process.

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CORE VALUE






HN

B-B

C®

Com

pete

ncie

s


•Articulate the relationship between the caring and healing concepts.

•Discuss and describe relations among coreHolistic Nursing concepts (e.g. Holism,Presence, Intentionality,UnconditionalAcceptance, Caring, Healing, etc., and selected extant Holistic Nursing theories; and

•Explain how they are used in one’s personal and professional lives.

Demonstrates:•Continued growth in expertise of Holistic Nursing.

•Ability to facilitate others in advancing their understanding of Holistic Nursing.

•Ability to apply research findings in the practice of Holistic Nursing

Demonstrates ability to facilitate self and others in advancement and application of self-care concepts/actions

Demonstrates ability to use culturally competent communication skills and techniques in the creation of caring environments.

Demonstrates ability to provide:

•Theoretically-basedindividual, family, group & communitycare, usingresearch findings, and

•Leadership in theadvancement of HolisticNursing in limitedsettings.

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CORE VALUE





5. HOLISTIC CARING PROCESSA

HN

-BC

® C

ompe

tenc

ies

Demonstrates ability to provide leadership in the application, analysis, synthesis and evaluation of Holistic Nursing concepts/ theories.

Demonstrates: •Continued growth in expertise of Holistic Nursing.

•Ability to provide mentorship and leadership in the advancement of Holistic Nursing

•Ability to design studiesand analyze researchfindings related to thepractice and advancementof Holistic Nursing


•Synthesize and evaluate self-care concepts and actions and

•Provide leadership in the advancement of self-care in the health-care arena

Demonstrates ability to:•Provide leadership in the creation and use of therapeutic environments and

•Mentor others in the acquisition of cultural competence.


•Providesophisticatedtheoretically-based, holisticcare to clients incorporating, appropriateresearch findings;

•Synthesize clinical cases to •evaluate nursing care effectiveness;

•Evaluate caring and healing activities in the nursing process; and

•Provideleadership for otherhealth-care providers inprovision of theory-based, research-supported care;

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CORE VALUE






APH

N-B

C®

Com

pete

ncie

s

Demonstrates ability to provide leadership in the application, analysis, synthesis and evaluation of Holistic Nursing concepts/ theories.

Demonstrates: •Continued growth in expertise of Holistic Nursing.

•Ability to provide mentorship and leadership in the advancement of Holistic Nursing

•Ability to design studiesand analyze researchfindings related to thepractice and advancementof Holistic Nursing


•Synthesize and evaluate self-care concepts and actions and

•Provide leadership in the advancement of self-care in the health-care arena


•Provide leadership in the creation and use of therapeutic environments and

•Mentor others in the acquisition of cultural competence.

Demonstrates ability to:•Providesophisticatedtheoretically-based, holisticcare to clients incorporating, appropriateresearch findings;

•Synthesize clinical cases to •evaluate nursing care effectiveness;

•Evaluate caring and healing activities in the nursing process; and

•Provideleadership for otherhealth-care providers inprovision of theory-based, research-supported care;

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APPENDIX D

NURSE COACH STANDARDS OF CARE AND COMPETENCIES

ANA Standard 1. Assessment

The registered nurse collects comprehensive data pertinent to the healthcare consumer’s health and/or the situation.

Professional Nurse Coach Role: Setting the foundation for coaching begins during the assessment phase of the coaching interaction. Assessment begins by becoming fully present with self and client before initiating the coaching interaction. Assessment proceeds to establishing relationship with the client and access to the client’s subjective experience/story and internal frame of reference through the cultivation and establishment of relationship. The Nurse Coach determines if the client’s concerns are appropriate for the coaching role. The Nurse Coach helps the client assess readiness for change. Assessment is dynamic and ongoing. The Nurse Coach:

1. Acknowledges, respects and affirms the client as the authority on his/her own health and well-being.

2. Explores the client’s reason for seeking a nurse-coach relationship at this time. 3. Assesses environment for distractions that might interfere with establishing a safe, trusting,

intimate relationship. 4. Partners with the client to co-create a relationship that promotes trust, intimacy, and self-

discovery. 5. Partners with the client to facilitate expression of the specific purpose of the coaching process. 6. Partners with the client to facilitate expression of client’s strengths and resources related to

purpose of coaching.7. Partners with the client to assess readiness for change.8. Partners with the client to assess the individual’s internal environment for distracters that

might interfere with the coaching process.9. Partners with client and seeks permission to explore areas of client vulnerability.10. Uses multiple types of knowing, including intuition, when facilitating client’s expression of

needs.11. Validates own intuitive knowing with the client when appropriate.12. Assesses client’s needs and coping abilities using focused interviewing skills.13. Uses appropriate evidenced-informed, whole person assessments techniques and

instruments to identify and clarify the client’s needs. 14. Assesses the match between the client’s needs and expectations, and the coach’s knowledge

and skills.

ANA Standard 2. Diagnosis

The registered nurse analyzes the assessment data to determine the diagnoses or the issues.

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Professional Nurse Coach Role: The Nurse Coach and the client together explore assessment data to determine areas for change. The Nurse Coach

15. Partners with clients to clarify their statements used to express their needs, concerns, strengths, and/or opportunities for change.

16. Confirms and validates clients’ needs, concerns, opportunities for change, and related strengths.

17. Interprets, analyzes, and synthesizes multiple sources of information acquired through the assessment process to identify patterns among client’s needs, concerns, and/or opportunities for change.

18. Documents the patterns detected in the analysis and synthesis of information in a safe and retrievable manner.

ANA Standard 3. Outcomes Identification

The registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation.

Professional Nurse Coach Role: The Nurse Coach assists the client to identify goals that will lead to the desired change. The Nurse Coach values the evolution and the process of change as it unfolds. The Nurse Coach:

19. Acknowledges that new goals will emerge as the client unfolds over time. 20. Facilitates clients to clarify and specify client-centered goals.21. Supports the client’s discovery of new goals as growth occurs. 22. Facilitates clients to specify expected outcomes that are clear, action-oriented, realistic, and

time-lined.23. Acknowledges that emergence of new goals will require revision of expected outcomes.24. Facilitates clients’ exploration and discovery of alternative goals and expected outcomes.25. Facilitates clients’ self-discovery, clarification, and validation of linkages among their needs,

the diagnoses, goals, and client’s expected outcomes

ANA Standard 4. Planning

The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes.

Professional Nurse Coach Role: The Nurse Coach and the client develop a coaching plan that identifies strategies to attain goals. The Nurse Coach:

26. Partners with the client to co-create an agreement that identifies the specific parameters of the relationship, including the roles and responsibilities of the Nurse Coach and the client.

27. Partners with the client to identify and plan for strategies needed to achieve the coaching goals, and effect expected outcomes.

28. Partners with the client to explore resources, laws, rules, and regulations related to the goals, strategies, and expected outcomes.

29. Partners with the client to explore alternative strategies that will produce expected outcomes, considering resources available, professional laws, rules and regulations.

ANA Standard 5. Implementation34/41

The registered nurse implements the identified plan.

Professional Nurse Coach Role: The Nurse Coach supports the client’s coaching plan while simultaneously remaining open to emerging goals based on new insights, learning, and achievements. The Nurse Coach supports the client in reaching for new and expanded goals. The Nurse Coach utilizes a variety of specific communication skills to facilitate learning and growth. The Nurse Coach:

At the beginning of each interaction

30. Centers and grounds self at the beginning of each coaching interaction. 31. Aligns own intention with the client’s goals.32. Partners with client to evaluate and minimize the potential effect of external distractions.33. Partners with client to terminate or reschedule coaching session when distractions interfere

with effective coaching interactions.

Throughout the coaching process

34. Remains fully present, centered, and grounded throughout the coaching process.35. Uses intentionality, aligned with client’s goals, throughout the coaching process.36. Maintains a curious, open, and reflective approach to the client’s verbal and nonverbal cues.37. Reflects on one’s own reactions to client.38. Uses multiple ways of knowing throughout the coaching process, including unknowing,

reflective, and integrative knowing.39. Accesses and trusts one’s own personal knowing (e.g. intuition and hunches/gut feelings).40. Uses techniques and strategies to create and maintain a safe, supportive environment that

fosters intimacy and trust.41. Demonstrates authenticity (honesty, sincerity, personal integrity). 42. Demonstrates respect for client’s subjective experiences expressed as stories and

perceptions. 43. Demonstrates respect and acceptance of client’s learning style and culture (e.g. beliefs,

values and customs).44. Acknowledges client resistance as an opportunity for self-awareness and growth.45. Chooses among a variety of coaching strategies or techniques that is expected to be most

effective given the situation at the time. 46. Uses sophisticated and holistic, verbal and non-verbal communication skills, including (but

not limited to) active listening, relevant use of language, and focused questioning 47. Partners with the client to facilitate and reinforce learning important to goal attainment.48. Uses relevant principles, models, and theories to facilitate learning and growth.49. Uses relevant strategies and/or modalities that facilitate mind-body-spirit-emotion-

environment integration 50. Empowers the client’s goal attainment.

At the end of the coaching interaction:

51. Effectively records, organizes, and reviews information, including past and current actions, with the client in a manner that facilitates the client in goal achievement.

52. Identifies and reviews client’s current status, planned goals, and expected outcomes.

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53. Identifies with the client the next specific action steps and a timeline that will lead to achievement of desired goals.

54. Assists the client to assume control over own progress by reviewing negotiated roles and responsibilities, including stated actions, results, and related time frames.

55. Partners with the client to review progress made during and between coaching interaction(s).

56. Partners with the client to determine the time of the next coaching interaction.57. Documents communications with client in a clear, concise, safe and easily retrievable

manner.

ANA Standard 6. Evaluation

The registered nurse evaluates progress toward attainment of outcomes.

Professional Nurse Coach Role: The Nurse Coach partners with the client to evaluate progress toward attainment of goals. The Nurse Coach:

58. Assists the client to evaluate goal attainment in respect to planned expected outcomes. 59. Supports the client’s determination of progress and success. 60. Partners with client to use findings from the evaluation process to reassess client’s needs,

preferred strategies, goals, and expected outcomes.61. Documents evaluation of progress and attainment of coaching goals.

ANA Standard 7. Ethics

The registered nurse practices ethically.

Professional Nurse Coach Role: The Nurse Coach integrates ethical provisions in all coaching interactions. The Nurse Coach:

62. Uses the Code of Ethics for Nurses with Interpretive Statements (ANA, 2008), the Position Statement on Holistic Nursing Ethics (AHNA, 2007) to guide practice and articulate the foundation of the Professional Nurse Coach Practice.

63. Demonstrates expertise in the six components of the Nurse Coach Process: Establishing a relationship and assessing readiness for change; identifying opportunities, issues, and concerns; establishing client-centered goals, and expected outcomes; creating the structure of the Coaching Interaction; empowering and motivating clients’ goal attainment; and assisting client’s evaluation of goal attainment.

64. Acknowledges that principles of holistic, human caring are central to the Nurse Coach’s practice.

65. Acknowledges that the nurse coaching process is based on a trusting, intimate nurse-client relationship.

66. Acknowledges that the nurse coaching process is a dynamic, systematic, and skilled process.67. Uses Holistic Nursing Principles to guide nurse-client interactions throughout the coaching

process. 68. Understands and effectively discusses with the client the ethical guidelines and specific

parameters of the Nurse Coaching relationship (e.g., logistics, fees, scheduling).

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69. Facilitates client’s expression of new ideas, behaviors, and actions that may involve risk-taking and fear of failure.

70. Clearly communicates and clarifies distinctions among coaching, consulting, counseling, and teaching to clients and others as indicated.

71. Partners with clients to individualize the Nurse Coach Process.72. Facilitates integration of body-mind-emotion-spirit-environment in the Nurse Coach Process.73. Supports the client’s inner wisdom, intuition, and innate ability for knowing what is best for

self throughout the Nurse Coach Process.74. Implements the Nurse Coach Process in a manner that promotes the client’s autonomy,

dignity, rights, values, beliefs, and strengths.75. Maintains an effective coaching relationship that is congruent with the coaching agreement

and within the boundaries of professional nursing practice.76. Performs the nurse coaching process by integrating knowledge, skills, intuition, and

judgment.77. Values all life experiences as opportunities to find personal meaning and cultivate self-

awareness, self-reflection, and growth. 78. Maintains client confidentiality within legal and regulatory parameters.

ANA Standard 8. Education

The registered nurse attains knowledge and competence that reflects current nursing practice.

Professional Nurse Coach Role: The Nurse Coach attains knowledge and competency that reflects current Nurse Coaching practice. The Nurse Coach:

79. Seeks and participates in ongoing educational activities to enhance own knowledge and skills needed to practice in the Nurse Coaching role.

80. Uses routine, self-reflective practices to assess own strengths and opportunities for improvement.

81. Seeks self-development opportunities specific to identified areas for improvement.82. Documents and maintains evidence of Nurse Coaching competency.83. Develops and utilizes a broad knowledge base related to holistic/integral nursing,

integrative health, health systems, coaching, counseling, health education, and nursing issues.

84. Seeks and develops competencies required for national certification as a Professional Nurse Coach.

ANA Standard 9. Evidence-Based Practice and Research

The registered nurse integrates evidence and research findings into practice.

Professional Nurse Coach Role: The Nurse Coach integrates evidence and research into Nurse Coaching practice. The Nurse Coach:

85. Utilizes the best available evidence, including theories and research findings to guide and enhance the Professional Nurse Coaching Practice.

86. Participates with others to establish research priorities and to identify research questions or areas for inquiry related to the Professional Nurse Coaching Practice.

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87. Participates in research activities related to the Professional Nurse Coaching Practice.

ANA Standard 10. Quality of Practice

The registered nurse contributes to quality nursing practice.

Professional Nurse Coach Role: The Nurse Coach systematically enhances the quality and effectiveness of Nurse Coaching practice. The Nurse Coach:

88. Participates in quality improvement activities to enhance the Professional Nurse Coaching Practice.

89. Contributes to the education of nurses, healthcare providers, and others concerning the Professional Nurse Coach Role.

90. Documents Nurse Coaching interactions in a responsible, accountable, and ethical manner to facilitate quality review and promotion of effective Nurse Coaching practice.

91. Uses creativity and innovation in Nurse Coaching practice to improve client outcomes.92. Analyzes organizational systems for barriers to effective implementation of the Professional

Nurse Coach Role.93. Advocates for the use of the Professional Nurse Coach Role: Defining the Scope of Practice

and Competencies to evaluate quality of practice.

ANA Standard 11. Communication

The registered nurse communicates effectively in a variety of formats in all areas of practice.

Professional Nurse Coach Role: The Nurse Coach employs skillful communication in all aspects of the coaching interaction. The Nurse Coach:

94. Understands that skillful, sophisticated communication is a fundamental and essential component of the Professional Nurse Coach relationship.

95. Uses sophisticated communication skills to enhance all aspects of the Coaching Process.96. Communicates with family, significant others, caregivers, health care providers, and others

to assist and enhance the client’s achievement of coaching goals, when requested by client.

ANA Standard 12. Leadership

The registered nurse demonstrates leadership in the professional practice setting and the profession.

Professional Nurse Coach Role: The Nurse Coach demonstrates leadership in the promotion of effective Nurse Coaching for clients. The Nurse Coach:

97. Advocates for the role of the Nurse Coach at work and in professional organizations. 98. Develops emotional and spiritual intelligence to enhance leadership skills. 99. Promotes the success of others by utilizing effective Nurse Coaching interventions. 100. Demonstrates energy, excitement, and a passion for quality Nurse Coaching.101. Demonstrates the ability to define a clear vision, associated goals, a plan to implement

and assess progress toward expected outcomes.

ANA Standard 13. Collaboration

The registered nurse collaborates with healthcare consumer, family, and others in the conduct of nursing practice.

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Professional Nurse Coach Role: The Nurse Coach collaborates with others to assist clients in achieving goals. The Nurse Coach:

102. Partners with others to promote nurse coaching as a way to enhance client outcomes. 103. Applies coaching skills with individuals and groups to identify and achieve individual,

group, and organizational goals.104. Refers client to other professionals and services as needed.

ANA Standard 14. Professional Practice Evaluation

The registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, and regulations.

Professional Nurse Coach Role: The Nurse Coach evaluates one’s own Nurse Coaching practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations. The Nurse Coach is engaged in ongoing personal and professional self-development. The Nurse Coach:

105. Utilizes the Professional Nurse Coach Role: Defining the Scope of Practice and Competencies (2012) to evaluate quality of practice.

106. Considers the effect of one’s personal values, culture, spiritual beliefs, experiences, biases, and education on the Nurse Coach services provided to individuals, groups, and organizations.

107. Provides Nurse Coaching services in a manner that is age-appropriate and sensitive to culture and ethnicity.

108. Engages in self-evaluation of coaching practice on a regular basis, identifying areas of strength as well as areas in which additional development would be beneficial.

109. Obtains evaluative feedback regarding one’s own coaching from clients, peers, and professional colleagues and takes appropriate action based upon the feedback.

110. Pursues Nurse Coach Certification as a way to demonstrate competency and to promote the Nurse Coaching role to employers, clients, and the public.

111. Recognizes that the Professional Nurse Coaching Practice is enhanced by ongoing self-development to promote physical, mental, emotional, social, and spiritual well-being.

ANA Standard 15. Resource Utilization

The registered nurse utilizes appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible.

Professional Nurse Coach Role: The Nurse Coach considers factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of Nurse Coaching services. The Nurse Coach:

112. Evaluates factors such as safety, effectiveness, availability, cost and benefits, efficiencies, and impact on Nurse Coaching practice when suggesting options for the client that would result in the same expected outcome.

113. Assists the client, as appropriate, in identifying and securing appropriate and available services to facilitate achievement of client goals.

ANA Standard 16. Environmental HealthThe registered nurse practices in an environmentally safe and healthy manner.

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Professional Nurse Coach Role: The Nurse Coach considers the impact of the internal and external environment of self and client when providing Nurse Coaching services. The Nurse Coach:

114. Acknowledges that healthy environments encompass both the internal and the external environment.

115. Recognizes that cultural, psychological, social, and historical factors influence the internal and external environment.

116. Considers the internal and external environmental resources of self and client regarding contribution to client goal achievement.

Relations Among Standards of Care, Competencies, and Core Values:

Mapping for Nurse Coach Certification Examination

Blue

prin

t for

Nur

se

Coac

h Ex

amin

ation

Core Value 1:

Nurse Coach Philosophy, Theory, Ethics

24%

Core Value 2:

Nurse Coaching Process

41%

Core Value 3:

Nurse Coach Communication and Coaching Environment

19%

Core Value 4:

Education, Research, and Leadership

11%

Core Value 5:

Self-Reflection, Self-Assessment, and Self-Care

5%

Competencies are related to Standards 1, 3, 5, 7, 11, 14

Competencies are related to Standards 1-7, 12-14

Competencies are related to Standards 2, 3, 5, 10-12, 16

Competencies are related to Standards

8-10, 12, 16

Competencies are related to Standards 5, 8, 14

9% 15% 38% 14% 5% 4% 3% 4% 5% Phil &

Theory Nurse Coach Ethics

Nurse Coach Process Nurse Coach Communication

Coach Environment

Ed

Research

Leadership

Self-reflection/assessment

Self-care

Stds:Comp.1: 1-14

1 2-14

2: 15-18

17-8 15-6

3: 19-25

19 22-5 20-1

4: 26-29

26-29

5: 30-57

30-1, 34-5, 39, 41-2, 44, 46

32-3

43, 45, 47-49,51-57

36, 46, 50

40 37-38

6:58-61

58-61

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7:62-78(79 deleted)

62, 64-78

63

8: 80-85

80, 82- 5

81

9: 86-88

86-8

10: 89-94

92-4 89-91

11: 95-97

95 96-7

12: 98-02

101-2 98 99-100

13: 103-5

103-5

14: 106-12(113 deleted)

106-8 111-112 109-110

15: -114-5

114-5

16:116-118

116-8

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