The Essentials

Domain 3: Population Health

Descriptor: Population health spans the healthcare delivery continuum from public health prevention to disease management of populations and describes collaborative activities with both traditional and non-traditional partnerships from affected communities, public health, industry, academia, health care, local government entities, and others for the improvement of equitable population health outcomes. (Kindig & Stoddart, 2003; Kindig, 2007; Swartout & Bishop, 2017; CDC, 2020).

Contextual Statement: A population is a discrete group that the nurse and others care for across settings at local, regional, national, and global levels. Population health spans the healthcare delivery continuum, including public health, acute care, ambulatory care, and longterm care. Population health also encompasses collaborative activities among stakeholders – all relevant individuals and organizations involved in care, including patients and communities themselves - for the improvement of a population’s health status. The purpose of these collaborative activities, including development of interventions and policies, is to strive towards health equity and improved health for all. Diversity, equity, inclusion, and ethics must be emphasized and valued. Accountability for outcomes is shared by all, since outcomes arise from multiple factors that influence the health of a defined group. Population health includes population management through systems thinking, including health promotion and illness prevention, to achieve population health goals (Storfjell, Wehtle, Winslow, & Saunders, 2017). Nurses play a critical role in advocating for, developing, and implementing policies that impact population health globally and locally. In addition, nurses respond to crises and provide care during emergencies, disasters, epidemics, or pandemics. They play an essential role in system preparedness and ethical response initiatives. Although each type of public health emergency will likely require a unique set of competencies, preparedness for responding begins with a population health perspective and a particular focus on surveillance, prevention, and containment of factors contributing to the emergency.

Implementing the Progression Indicators
One-Pager Guides & Videos

 

Progression Indicators:
An Overview

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In this video, Drs. Bimbola Akintade and Cynthia O'Neal from AACN's Assessment Expert Working Group introduce the progression indicators and how incorporating them into nursing curricula can improve competency assessment strategies.

Clarifying Expectations & Advancing Competency With PIs

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Dr. Mary Fey discusses the importance of aligning descriptive, observable behaviors with the Essentials sub-competencies for student assessment.

Clustering Competencies During Assessment

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Dr. Dana Tschannen provides an overview of how faculty can cluster Essentials competencies to ensure alignment throughout program curricula.

 

Competencies, Sub-competencies, and Progression Indicators Table by Level

Below presents sub-competencies by entry-level and advanced-level, with associated progression indicators. Select a competency from the dropdown to view its corresponding table of developing and developed competence. 

Table Legend:

Level 1: Entry-Level
Level 2: Advanced-Level

  Sub-competency Progression Indicators (Observable Behaviors)
    Developing (Developing Competence) Developed (Competent)
Level 1: Entry-Level

3.1a Define a target population including its functional and problem-solving capabilities (anywhere in the continuum of care).

Describe the defining characteristics of a target population.

Identify demographic, functional, and educational characteristics within a specific target population.

3.1b Assess population health data.

Identify key sources of population health data.

Access pertinent population health data.

Evaluate population health data to determine health risks within an identified population.

3.1c Assess the priorities of the community and/or the affected clinical population.

Identify key stakeholders within a community.

Gather relevant assessment data to inform population health initiatives.

Collaborate with community members and leaders to develop a shared understanding of community health priorities.

3.1d Compare and contrast local, regional, national, and global benchmarks to identify health patterns across populations.

Identify relevant health indicators across local, regional, national, and global contexts.

Compare health statistics across geographic regions to identify disparities and opportunities for intervention.

Analyze qualitative and quantitative data to identify emerging health trends and needs within a community.
3.1e Apply an understanding of the public health system and its interfaces with clinical health care in addressing population health needs. Explain the role of the public health system in disease prevention, health promotion, and population protection. Analyze the impact of public health interventions on clinical practice and population health outcomes.

3.1f Develop an action plan to meet an identified need(s), including evaluation methods.

Define the essential elements of an action plan using the nursing process.

Choose evidence-based nursing interventions to improve public health outcomes.

Integrate complex data and evidence to design actionable and sustainable plans for addressing population health issues.

3.1g Participate in the implementation of sociocultural and linguistically responsive interventions.

Articulate the role of culture and language in patient care to enhance communication and demonstrate respect.

Collaborate with healthcare teams to implement culturally responsive nursing interventions.

3.1h Describe general principles and practices for the clinical management of populations across the age continuum.

Identify key developmental stages and age-related health issues within a population.

List age-appropriate interventions and communication techniques.

Apply evidence-based practices to address the unique needs of populations across the age continuum.

3.1i Identify ethical principles to protect the health and safety of diverse populations.

Explain core ethical principles in healthcare.

Articulate how ethical principles guide the protection of diverse populations' health and safety.
       
Level 2: Advanced-Level

3.1j Assess the efficacy of a system’s capability to serve a target sub-population’s healthcare needs.

Identify key factors influencing a healthcare system's ability to meet population needs. Use systematic assessment and data analysis to evaluate the healthcare system’s effectiveness in addressing specific population health needs.

3.1k Analyze primary and secondary population health data for multiple populations against relevant benchmarks.

Evaluate the quality and reliability of health data sources.

Identify relevant benchmarks for comparative analysis.

Apply data analysis techniques to identify trends, patterns, and disparities in health outcomes across populations.

3.1l Use established or evolving methods to determine population-focused priorities for care.

Analyze the feasibility of various methods to determine population-focused care priorities. Assess and adjust care priorities in response to population needs, emerging healthcare trends, and evolving scientific evidence.
3.1m Develop a collaborative approach with relevant stakeholders to address population healthcare needs, including evaluation methods. Analyze complex organizational structures to build effective partnerships. Evaluate the effectiveness of collaborative efforts to improve healthcare partnerships.

3.1n Collaborate with appropriate stakeholders to implement a sociocultural and linguistically responsive intervention plan.

Contribute to the development of culturally responsive care strategies by integrating stakeholder input.

Lead collaborative efforts to implement and evaluate sociocultural and linguistically responsive interventions.

 

Table Legend:

Level 1: Entry-Level
Level 2: Advanced-Level

  Sub-competency Progression Indicators (Observable Behaviors)
    Developing (Developing Competence) Developed (Competent)
Level 1: Entry-Level 3.2a Engage with other health professionals to address population health issues.

Participate in discussions with healthcare professionals about developing and implementing population health initiatives.

Collaborate with interdisciplinary teams to design, implement, and evaluate population health programs to enhance healthcare outcomes.

3.2b Demonstrate effective collaboration and mutual accountability with relevant stakeholders.

Demonstrate effective communication skills to facilitate collaboration.

Identify key elements of effective collaboration.

Model accountability for individual actions and contributions to team objectives.

Apply conflict management strategies to resolve disagreements constructively and maintain professional relationships.

3.2c Use culturally and linguistically responsive communication strategies.

Identify common cultural and linguistic barriers to healthcare delivery.

Apply culturally and linguistically appropriate communication strategies when interacting with patients and families.

Adapt communication styles to meet the needs of populations, ensuring inclusivity and effectiveness.

Collaborate with interpreters and translators to facilitate accurate and meaningful communication with populations.

       
Level 2: Advanced-Level 3.2d Ascertain collaborative opportunities for individuals and organizations to improve population health.

Identify key stakeholders and health initiatives addressing the needs of specific populations.

Develop relationships with community organizations and healthcare providers to facilitate meaningful collaboration.

Develop and implement collaborative initiatives designed to improve population health outcomes.
3.2e Challenge biases and barriers that impact population health outcomes.

Identify prevalent biases and stereotypes influencing healthcare delivery.

Challenge personal biases and stereotypes to enhance clinical judgment and decision-making.

Design and implement evidence-based interventions to mitigate biases and barriers to equitable healthcare.

3.2f Evaluate the effectiveness of partnerships for achieving health equity. Identify key factors contributing to successful and effective partnerships in healthcare.

Analyze outcome data related to partnership goals and assess the impact on health equity.

Develop and evaluate plans for the long-term sustainability of partnerships to ensure continued progress in addressing healthcare disparities.

3.2g Lead partnerships to improve population health outcomes.

Establish and nurture strong relationships with key stakeholders to promote collaboration.

Identify leadership roles within population health initiatives.

Apply leadership theories to enhance communication and teamwork.

Delegate tasks and responsibilities effectively to maximize efficiency and impact.

Assess team performance and make necessary adjustments to optimize outcome effectiveness.

3.2h Assess preparation and readiness of partners to organize during natural and manmade disasters.

Identify gaps in preparedness and response plans for both natural and manmade disasters.

Develop strategies to improve preparedness and response capabilities.

Lead collaborative efforts with partners to strengthen disaster response plans.

Mentor and coach partners in disaster preparedness and response.

Table Legend:

Level 1: Entry-Level
Level 2: Advanced-Level

  Sub-competency Progression Indicators (Observable Behaviors)
    Developing (Developing Competence) Developed (Competent)
Level 1: Entry-Level 3.3a Describe access and equity implications of proposed intervention(s).

Describe the potential effects of the proposed interventions.

Develop strategies to mitigate barriers and promote equitable access to interventions.
3.3b Prioritize patient-focused and/or community action plans that are safe, effective, and efficient in the context of available resources

Define prioritization frameworks.

Identify the feasibility and urgency of potential action plans.

Select action plans based on evidence and available resources.

Choose the prioritization framework that is aligned with the context.

Collaborate with community partners to prioritize community needs.

Prioritize action plans that are population-centered and culturally appropriate.

       
Level 2: Advanced-Level 3.3c Analyze cost-benefits of selected population-based interventions.

Identify key factors to consider when evaluating the cost-effectiveness of interventions.

Compare the cost-effectiveness of different intervention strategies.

Evaluate the economic impact of interventions.

Advocate for policies and programs prioritizing cost-effective interventions.

3.3d Collaborate with partners to secure and leverage resources necessary for effective, sustainable interventions.

Assess resources available to support interventions with the selected population.

Develop customized strategies to maximize resource utilization.

Lead interprofessional teams in resource acquisition and management.

Collaborate with decision-makers to allocate resources effectively.

3.3e Advocate for interventions that maximize cost effective, accessible, and equitable resources for populations.

Develop strategic relationships with policymakers, community leaders, healthcare providers, and other stakeholders.

Use data to support arguments for identified interventions.

Propose data informed interventions to policymakers, stakeholders, and community leaders.

3.3f Incorporate ethical principles in resource allocation in achieving equitable health.

Apply relevant ethical principles to resource allocation decisions.

Evaluate the ethical implications of different resource allocation strategies.

Justify resource allocation decisions.

Lead initiatives to address equitable resource allocation.

Evaluate the impact of resource allocation decisions on health equity.

Table Legend:

Level 1: Entry-Level
Level 2: Advanced-Level

  Sub-competency Progression Indicators (Observable Behaviors)
    Developing (Developing Competence) Developed (Competent)
Level 1: Entry-Level

3.4a Describe policy development processes.

Identify key components of health policy.

Outline the process for drafting, reviewing, and finalizing a policy document.

3.4b Describe the impact of policies on population outcomes, including social justice and health equity.

Identify examples of health policies influencing health outcomes, social justice, and health equity.

Use population outcome data to analyze the effectiveness of policies.

3.4c Identify best evidence to support policy development.

Explain the role of evidence-based practice in shaping policy.

Identify sources of health data to support policy development.

Choose relevant evidence to support policy development.

3.4d Propose modifications to or development of policy based on population findings.

Identify potential policy improvements to support desired population health outcomes.

Advocate for policy modifications using data-driven arguments.

3.4e Develop an awareness of the interconnectedness of population health across borders.

Identify basic concepts of globalization and their relevance to health.

Evaluate the effectiveness of international health initiatives in addressing global health issues.

       
Level 2: Advanced-Level

3.4f Identify opportunities to influence the policy process.

Describe key policy areas where nurses can have an impact.

Analyze healthcare trends and challenges to identify gaps or needs that could be addressed through policy.

Identify barriers and facilitators to achieve positive outcomes through policy change.

3.4g Design comprehensive advocacy strategies to support the policy process.

Develop clear advocacy goals and objectives for specific policy outcomes.

Choose appropriate advocacy strategies to achieve goals and objectives.

3.4h Engage in strategies to influence policy change.

Implement advocacy strategies with measurable action steps.

Demonstrate leadership by initiating advocacy-related activities.

3.4i Contribute to policy development at the system, local, regional, or national levels.

Identify opportunities for improving policy.

Demonstrate engagement in policy work by participating in initiatives at the system, local, state, or national level.

3.4j Assess the impact of policy changes.

Monitor policy outcomes and their impact on health care delivery, patient outcomes, and professional practice.

Analyze feedback and data to assess the effectiveness of the policy and recommend improvements if needed.

3.4k Evaluate the ability of policy to address disparities and inequities within segments of the population.

Assess policy effectiveness in reducing disparities and inequities.

Interpret data to determine whether the policy effectively reduces inequities or perpetuates existing disparities.

3.4l Evaluate the risks to population health associated with globalization.

Analyze global health data to identify trends in population health risks associated with globalization.

Evaluate global policies and interventions for their cultural appropriateness and responsiveness to diverse populations.

 

Table Legend:

Level 1: Entry-Level
Level 2: Advanced-Level

  Sub-competency Progression Indicators (Observable Behaviors)
    Developing (Developing Competence) Developed (Competent)
Level 1: Entry-Level

3.5a Articulate a need for change.

Describe common health disparities and unmet needs in different populations.

Develop evidence-based arguments for population health changes using data and evidence.

3.5b Describe the intent of the proposed change.

Identify key drivers of a change proposal.

Develop a compelling description of the proposed change using data and evidence.

3.5c Define stakeholders, including members of the community and/or clinical populations, and their level of influence.

Define stakeholders and their roles in health advocacy initiatives.

Determine the stakeholders that would be influential in achieving a proposed change.

3.5d Implement messaging strategies appropriate to audience and stakeholders.

Identify communication methods used to engage stakeholders.

Develop messaging strategies for selected stakeholders.

Align the method of communication with the context.

Refine and deliver persuasive messages to stakeholders aligning with their priorities and goals.

3.5e Evaluate the effectiveness of advocacy actions.

Describe the key metrics and indicators used to evaluate advocacy efforts.

Develop evaluation plans for advocacy initiatives.

Analyze outcomes of advocacy actions.

       
Level 2: Advanced-Level

3.5f Appraise advocacy priorities for a population.

Use evidence to evaluate specific advocacy priorities.

Modify advocacy priorities based on their potential impact on patient care, outcomes, and systems.

3.5g Strategize with an interdisciplinary group and others to develop effective advocacy approaches.

Identify and engage with relevant stakeholders to gather diverse perspectives and expertise.

Describe potential advocacy approaches.

Develop a collaborative advocacy plan by integrating input from multiple stakeholders and disciplines.

3.5h Engage in relationship-building activities with stakeholders at any level of influence, including system, local, state, national, and/or global.

Develop and implement strategies for sustaining long-term, mutually beneficial relationships with stakeholders.

Evaluate and refine strategies for engaging stakeholders, fostering collaboration, and addressing potential barriers to relationship-building.

3.5i Demonstrate leadership skills to promote advocacy efforts that include principles of social justice, diversity, equity, and inclusion.

Identify leadership approaches to promote advocacy initiatives using principles of cultural humility, inclusivity, social justice, and diversity.

Evaluate the effectiveness of leadership skills used to promote advocacy initiatives.

Table Legend:

Level 1: Entry-Level
Level 2: Advanced-Level

  Sub-competency Progression Indicators (Observable Behaviors)
    Developing (Developing Competence) Developed (Competent)
Level 1: Entry-Level

3.6a Identify changes in conditions that might indicate a disaster or public health emergency.

Describe potential disasters or public health emergencies.

Describe conditions indicating an impending disaster or public health emergency.

Analyze data and trends to identify early warning signs of disasters or public health emergencies.

Discuss protocols for early detection and response to disasters or public health emergencies.

3.6b Understand the impact of climate change on environmental and population health.

Describe foundational concepts of climate change and its potential impact on human health.

Identify vulnerable populations at increased risk due to climate change.

Explain the link between climate factors and the spread of infectious diseases.

Explain the complex relationship between climate change, environmental factors, and human health.

Assess health risks for specific populations and communities impacted by climate change.

3.6c Describe the health and safety hazards of disasters and public health emergencies.

List common health hazards associated with different types of disasters.

Identify potential psychological and social impacts of disasters on individuals and communities.

Describe basic principles of emergency preparedness and response.

Assess the potential impact of various disasters on healthcare systems and community infrastructure.

Describe disasters' psychological and social consequences and their impact on recovery efforts.

3.6d Describe the overarching principles and methods regarding personal safety measures, including personal protective equipment (PPE).

Explain the importance of following safety protocols during disasters and emergencies.

Identify components of appropriate PPE for different situations.

Describe principles of decontamination and infection control in emergency settings.

3.6e Implement infection control measures and proper use of personal protective equipment.

Demonstrate hand hygiene and other infection control techniques.

Don and doff PPE for standard precautions.

Participate in simulated disaster drills incorporating basic infection control measures.

Implement infection control measures in various clinical and emergency settings.

Demonstrate proficiency in using PPE for various types of isolation.

       
Level 2: Advanced-Level

3.6f Collaboratively initiate rapid response activities to protect population health.

Identify potential roles and responsibilities in emergency response plans.

Develop strategies to lead rapid response teams during public health emergencies.

Assess and address urgent public health needs in emergency situations.

3.6g Participate in ethical decision making that includes diversity, equity, and inclusion in advanced preparedness to protect populations.

Describe the importance of addressing health disparities and social determinants of health in emergency preparedness planning.

Identify vulnerable populations at increased risk during emergencies and advocate for their needs.

Participate in discussions about ethical considerations related to resource allocation and triage during disasters.

Advocate for equitable access to healthcare resources and services for all populations during emergencies.

Make ethical decisions regarding resource allocation and triage, prioritizing the needs of the most vulnerable.

Integrate social justice and health equity principles into various emergency preparedness and response aspects.

3.6h Collaborate with interdisciplinary teams to lead preparedness and mitigation efforts to protect population health with attention to the most vulnerable populations.

Contribute to the development of interdisciplinary emergency preparedness plans for specific populations or communities.

Participate in interdisciplinary community outreach and education efforts to increase awareness of disaster preparedness.

Develop interdisciplinary community-based programs to improve disaster preparedness and resilience.

Engage in interdisciplinary collaboration with community organizations on issues related to disaster preparedness.

3.6i Coordinate the implementation of evidence-based infection control measures and proper use of personal protective equipment.

Reinforce evidence-based infection control measures by supporting proper PPE use, assisting with protocol implementation, or educating peers, as appropriate, in collaboration with interdisciplinary teams.

Identify resources for securing appropriate PPE.

Develop comprehensive infection control protocols for emergency settings.

Evaluate infection control practices to identify areas for improvement.

3.6j Contribute to system-level planning, decision making, and evaluation for disasters and public health emergencies.

Evaluate emergency response activities and identify areas for improvement.

Propose evidence-based system-level improvements to emergency preparedness and response plans.