SALT LAKE COMMUNITY COLLEGE PHILOSOPHY OF THE NURSING PROGRAM The philosophy of the nursing program is consistent with the mission statement and values of Salt Lake Community College. The mission of the College states that Salt Lake Community College is a public, open-access, comprehensive community college committed to serving the broader community. Its mission is to provide quality higher education and lifelong learning to people of diverse cultures, abilities, and ages, and to serve the needs of community and government agencies, business, industry and other employers. Students are our highest priority. In harmony with this priority, the college values are community, creativity, diversity, environment, excellence, expression, integrity, and people. Salt Lake Community College is an equal opportunity institution providing educational and employment opportunities without regard to race, color, religion, sex, national origin, age, or disability. The nursing faculty s philosophy is eclectic and based on a humanistic and holistic orientation of nursing which emphasizes the value of individual existence and places high priority on caring for people. In accord with the tenets of the philosophy, the faculty acknowledges the importance of the individual and society in relation to health, nursing, and education. DEFINITIONS Faculty has defined the following terms regarding nursing and nursing education: Society The individual interacts dynamically and holistically with society. Society consists of a diverse population of various cultures, races, socioeconomic levels, religions, and lifestyles. Environmental changes, the economy, politics, family, structure, and cultural practices, in addition to evolving social concerns and health care delivery, are all societal influences to which an individual must respond. Actions are influenced by learned behavior and cultural expectations. Environmental changes, economy, politics, family structure, social concerns, and health care delivery systems influence the environment in which nurses are educated and practice. Health Health is a dynamic state of being in the life cycle of the individual. Health is a sense of well being that can be described in physical, emotional, intellectual, social, and spiritual terms. Health is not merely the absence of disease but is the optimal level of functioning for each individual. Health and illness are inevitable dimensions of the person s life and are not mutually exclusive. Individuals have an inherent right to be active participants in achieving health, as they perceive it. Health is influenced by heredity, perception of physical and psychosocial environment, philosophy, and lifestyle. 1
Nursing Nursing is a profession, a practice and an academic discipline concerned with promoting, maintaining, and restoring health. Nurses interact holistically with clients and are concerned with all people in various stages of health regardless of age, sociocultural, or economic background. Nursing practice extends beyond the individual to family, groups, and community. Education The education process involves the acquisition of information and the transformation of that information to usefulness through knowledge, comprehension, application, analysis, synthesis, and evaluation. Education is a life-long process, which promotes the development of knowledge, skills, and personal values. Learning is a dynamic, intellectual, and emotional experience that empowers learners to their fullest potential. The adult learner utilizes critical thinking skills to integrate theory and practice. The Learner Each learner brings to the educational situation unique life experiences and varying cultural and ethnic backgrounds. The program is responsive to individual needs, differences, learning abilities, and support systems. The learner is a consumer of information and is responsible for his/her own learning. The learner interacts in a process where the student gains competency to function safely within the appropriate scope of nursing practice. The SLCC nursing program has established competency-based criteria for admission, progression, and graduation in an attempt to strengthen the student at the associate degree level to assure the positive self-image and readiness to learn and practice. The student then interacts with the educator in a purposeful, goal-directed manner. The Educator The educator s role is to provide support, direction, and creative learning experiences for the student as advisor, facilitator, and role model. The educator strives to create an environment that promotes personal expression and development of new ideas. It is this environment which promotes active participation and collaboration of the learner through application of the problem-solving process and development of critical thinking skills. The educator promotes the learner s ability to accomplish the objectives of the learning program by evaluating and reinforcing the student's assimilation of knowledge. The educator facilitates the personal and professional growth of each unique learner by facilitating a student s natural ability to learn. Learning occurs more readily in an accepting and stimulating environment where students are free to express themselves. Teaching/Learning Faculty utilizes teaching and learning theories to organize and evaluate learning situations. Faculty recognizes the need for individuals to develop skills of creative/critical thinking for higher-order learning to occur. Teaching/learning is a collaborative process between the educator and the learner. 2
TRENDS Nursing Education Nursing education is based upon knowledge derived from nursing, biological, physical science, social science and liberal arts. Nursing is also an art practiced in the context of caring relationships with human beings. Nursing is a process of self-realization whereby adults assimilate and synthesize knowledge, cultivate critical thinking abilities, become adept with technical and communication skills, develop nursing care strategies based on standards of care, evolve personal potential, and establish values. As society changes, nursing must be responsive to changes in the environment. Health care delivery has been and remains in a dynamic state. Environmental trends include: Focus on Management of Chronic Conditions Emphasis is being placed on management of chronic conditions in an attempt to prevent and/or delay development of complications. Shift of Care into the Community Healthcare is moving from centralized acute care into diverse community settings, including the home. Aging Population Life expectancy is increasing. Most of these individuals will eventually experience chronic and/or disabling illnesses, and many will require long-term care. Increasing Cultural Diversity The richness of cultural differences in both the client and healthcare worker is being recognized and considered as a more significant factor in healthcare delivery. Technology Advances The impact of technology-based education and practice is changing the environment in which nurses practice. THE NURSE The associate degree nurse assumes three basic roles in practice: Provider of care, manager of care, and member within the discipline. Provider of Care As a provider of care, the nurse utilizes the nursing process to formulate and implement nursing care for individuals who have health care needs. The nurse is concerned with promoting, maintaining, and/or restoring the client to an optimum state of health. The nurse may also support the client to die with dignity. The nurse utilizes the nursing process to facilitate critical thinking required to make sound judgments and to demonstrate competent practice. The nurse provides information for the individual, the 3
community, and health care providers through effective communication. The nurse s commitment to client-centered care is reflected through a collaborative approach involving the client, family, significant others, and members of the health care team. Manager of Care As a manager of care, the associate degree nurse provides and coordinates care for a group of clients who have health care needs. Collaboration, organization, delegation, accountability, advocacy, and respect for other health care workers characterize the practice of the associate degree nurse. The associate degree nurse may delegate certain aspects of care to licensed practical nurses and/or to personnel commensurate with their education and experience. The nurse retains accountability for care delegated to others and knows the legal parameters of other care providers roles, responsibilities, and scopes of practice. The associate degree nurse seeks consultation with other professionals when situations beyond his/her knowledge and experience occur. To be competent in the role of manager of care, the nurse must possess the knowledge and skills necessary to make decisions about priorities of care, to delegate aspects of nursing care to others, to utilize time and resources, and to know when to seek assistance. This requires knowledge of client care management, communication, delegation, legal parameters of nursing practice, and roles and responsibilities of members of the health care team. Member of Profession As a member within the nursing profession, the nurse demonstrates accountability, autonomy, and authority in practice. The Utah Nurse Practice Act, the American Nurses Association Code of Ethics, and current standards of practice guide nursing practice. The nurse practices within the ethical and legal framework of the nursing profession and is responsible for ensuring high standards of nursing practice. The nurse s role as a member of the profession and of the healthcare team is to provide holistic, client-centered care and to maintain patient advocacy. The nurse contributes to the improvement of nursing by remaining a lifelong learner. The nurse actively supports the continued growth and positive image of the profession. The nurse understands the importance of nursing research, rules, and regulations governing the practice of nursing, roles of professional organizations, and political, economic, and societal forces affecting practice. Basic concepts of management are incorporated into the practice of the associate degree nurse. 4
NURSING CATEGORIES The nursing faculty differentiates between the practical nurse, the associate degree nurse, and the baccalaureate prepared nurse by the following descriptions: The practical nurse functions primarily in structured health care settings such as hospitals, nursing homes, and clinics where the policies and procedures and protocols for provision of care are established and there is ready recourse for assistance and support from the registered nurse. The practice of practical nursing is designed to promote and maintain health, prevent illness and injury, and provide care utilizing standardized procedures and the nursing process, including administering medication and treatments under the direction of the licensed professional nurse. The associate degree nurse provides and coordinates care for groups of clients with more complex health care needs, adjusting care as the situation changes. The level of responsibility of the associate degree nurse is for a specified work period and is consistent with identified goals of care. The associate degree nurse is prepared to function both within acute care and long term care settings where policies and procedures are specified and guidance is available. Associate degree nurses maintain professional relationships by advocating and supporting client decisions, and by collaborating and communicating with clients, families, and other health care professionals. In providing care, the associate degree nurse may delegate aspects of care to licensed and unlicensed personnel. In delegating the care to others, associate degree nurses remain accountable for care of their own clients and clients delegated to others under their direction. The baccalaureate degree nurse cares for clients who are identified as individuals, families, and community groups. The level of responsibility of the baccalaureate nurse is from admission to post discharge. This nurse is prepared to function in a wide variety of health care settings. The setting in which the baccalaureate nurse practices may or may not have established protocols, procedures, and policies, and also has the potential for variations requiring independent nursing decisions. THE CURRICULUM The Nursing Division conceptual framework directs SLCC nursing faculty as they make curricular decisions. A model of the conceptual framework illustrates the central components of the program, which are: 1) the client, which serves as the umbrella, 2) the health continuum, which houses 3) caring, 4) the nurse as provider of care, manager of care, and member of the discipline. Students initially work with clients who have common recurring body system needs. As the program progresses, content is presented in greater complexity and depth. Learning progresses as the student assumes more roles of the associate degree nurse. The student s definition of client begins as an individual. By the end of the program, students recognize that clients can also be families, groups, and communities. 5
Clients Clients (human beings) are holistic beings. The faculty views the client as a biological, psychological, developmental, sociocultural, and spiritual being, with the unique capacity to experience emotions. Individuals exist, develop, and interact within the context of their families, communities, and societal environments. Each individual is unique and has intrinsic worth. Clients have the right to make their own decisions and to reach their maximum potential. Human beings strive for a sense of balance and well-being within a societal context. Clients interface with nurses as they intervene at primary, secondary, and tertiary points along the health-care continuum. Heath Continuum The health continuum is a dynamic state of wellness requiring nursing interventions focused on health promotion, restoration, and rehabilitation. Clients may be at any point on the continuum at any time during the growth and development process. Nurses may assist clients to a maximum state of wellness within the client s potential or assist in providing a dignified decline and death. Caring Caring includes the recognition and acknowledgment of the value of individuals, families, and communities. Caring interventions are nursing behaviors and actions that assist clients to meet their needs. Caring is learned and practiced and does not happen by chance. In a professional setting, caring nursing interventions begin by the valuing of all people. CURRICULAR THREADS The curricular threads, woven throughout the Nursing Program, include: 1) body systems/basic needs, 2) communication, 3) cultural diversity, 4) critical thinking, 5) growth and development, and 6) nursing process. Organized and presented in terms of complexity and scope of nursing practice, the knowledge base of didactic content is expanded and developed as the learner progresses through the curriculum. Body Systems/Basic Needs Nursing information is organized for presentation to the students by body systems. Communication Consists of verbal, nonverbal, written, oral, and technological means of communicating with other health care professionals and clients to meet client needs and implement change. 6
Cultural Diversity Refers to the recognition of differences and similarities among individuals and groups related to expectations and behaviors. Recognizing and respecting diversity enhances one s view of the world and promotes personal and professional growth. Critical Thinking Incorporates skills in reasoning, analysis, and decision-making relevant to the discipline of nursing demonstrated by openness of inquiry and the ability to ask questions, generate ideas, and offer perspectives. Growth and Development Focuses on transitions that humans experience and which influence maintenance, restoration, and/or promotion of health. Human development refers to the myriad of changes whereby the individual differentiates and increases in complexity. Nursing is concerned with human beings of all ages and stages of growth and development in the life cycle. Basic human developmental needs are interrelated and involve physical, psychological, developmental, environmental, sociocultural, and spiritual aspects of the person. The Nursing Process The nursing process is designed to identify client needs, to inform nursing activity that promotes the client s health to his/her optimum level and to evaluate the client s progression toward a health care goal collaboratively developed with the client. The nursing process is a problem-solving approach to client care, which enables the nurse to systematically analyze stressors and evaluate the client s ability to adapt and react to them. The steps of the nursing process include: Assessment Assessment is defined as acquisition of client information through client interview, review of existing records and reference materials (subjective database), and physical and environmental assessment/observation of the client (objective database). Nursing Diagnosis/Collaborative Problem Identification Nursing diagnosis provides the framework for assimilation of assessment data into diagnoses that can be communicated to other health care personnel. Goal Setting In collaboration with the client, nursing diagnoses are used to identify clientcentered health goals that are attainable, measurable, and agreeable to the individual. 7
Intervention Interventions are specific steps that move the client toward achievement of the predetermined goal(s) Evaluation Interventions are evaluated for efficacy and necessity and modified as required. Likewise, goals are resolved, modified, or added as the individual s circumstance changes. The nurse uses the nursing process to assist the individual to achieve the highest possible level of health. The nurse functions dependently, independently, and collaboratively with the individual and with other members of the health team in activities that include health promotion, maintenance, restoration, and rehabilitation. Nursing practice requires competence in the performance of essential nursing skills that utilize cognitive, psychomotor, affective capabilities, and critical thinking. The nurse is involved in a lifelong process of learning to ensure that client care is current and evidence-based. Inquiry and creativity encourage continued learning and participation in research to generate quality nursing care for all human beings. 8
Client Health Continuum Caring THREADS Provider Of Care Nursing Student Manager Of Care Body Systems/Basic Needs Communication Cultural Diversity Critical Thinking Growth and Development Nursing Process Member Of the Profession 9