The Faculty Believes:
Major concepts, which are interrelated and permeate the entire curriculum, are organized into four interdependent conceptual constructs: nursing, person, health, and environment. Sub concepts are deduced from the four concepts and serve to organize the process and the content of the nursing curriculum. Together, the major concepts and, sub concepts and the curricular threads form an interactive unified curriculum. The philosophy and organizing framework provide guidance in the establishment of educational outcomes, course student learning outcomes, the sequencing of course content and the program in general.
The setting of the Associate Degree in Nursing program includes the College, the community, the health care system, and the profession. Teaching at Ventura College occurs in many various settings such as the classroom, hospital, clinic, laboratory, seminar, and community. Ventura College is committed to the principle that this educational process is most effectively carried out in the context of the creation of new knowledge, and therefore Ventura College puts a premium on scholarship and on professional credentials of its faculty.
- Is a complex, ever-changing, physical-psycho-socio-cultural-spiritual being with innate worth, dignity and the right to self-determination
- Is viewed within the context of his/her dynamic environment as he/she progresses from conception through the end of life (LIFESPAN)
- Has the capacity for self-care, with the right to make decisions regarding well-being, health and illness
- Can be an active participant in self care and health care and will use various teaching/learning approaches to facilitate this participation.
Self Care (Person):
Self -care is the practice of activities that individuals personally initiate and perform on their own behalf in maintaining life, health and well-being. The individual has capacity for self-care, and self-care is an adult's personal, continuous contribution to his own health and well-being. When an individual is unable to meet therapeutic self-care demands, a self-care deficit ensues. This self-care deficit can result from a developmental need for total care (illness, injury, disability). the identification of nursing diagnoses by the nurse results from assessment of universal, developmental and self-care requisites. The extent of nursing care (nursing agency) required is determined by the capability of the patient and/or family to provide self-care. Nursing utilizes the nurse to balance the inequality between self-care demand and self-care agency.
Target Population (Person):
- The target population of Ventura College, School of Nursing, consists of individuals, families, groups and communities in Ventura County. Ventura is a county composed of an ethnically, economically and demographically diverse population. Refugees, immigrants, and homeless live in this community. The school serves this diverse community of clients who present with health care needs occurring across the life span and in all stages of human development. Utilization of the surrounding health care facilities provides a rich environment for nursing practice as nurses address the health care problems indigenous to the area. Health care services are available at public and private facilities. Major challenges facing this community include access to affordable health care and high mortality rates for certain populations, such as infants and the elderly, substance abusers and the psychiatrically ill without support services.
- The family is a group of individuals with a continuing legal, genetic and/or emotional relationship. society relies on the family group to provide for the economic and protective needs of individuals, especially children and the elderly (American Association of Family Physicians, 2003). Traditionally, family structure was either nuclear or extended, but now the definition of family has changed to include single-parent families, blended families, bi-nuclear, communal, and gay/lesbian family structures. Nurses must be able to meet the needs of children from many diverse family structures and home situations (Hockenberry & Wilson, 2009). Nurses must also be able to meet the health care needs of groups of patients. Groups are a collection of individuals with structural characteristics defined by composition, location, size, group norms, role relationships,and social systems (Hunt, 2001). Nurses use knowledge about these characteristics to explain the way individuals interact with each other. Nurses also work as an interactive group of professionals on tasks requiring problem solving and a great deal of teamwork (Shortell & Kaluzny, 1997).
- continually evolving and changing process which the individual defines and in which he/she must participate
- The structural and functional integrity of the individual
- Determined by the individual’s values, beliefs, age , gender, and ability to meet self-care requisites or health deviations
- Defined by the patient in relation to basic conditioning factors such as age, sex, cultural values, education and socioeconomic status
- Subjectively experienced, a perceived condition of well-being, and exists experientially on a continuum with illness as its antithesis
- a state of balance, an equilibrium that an individual has established within himself and between himself and his social and physical environment.
- is a disruption in perceived integrity or wholeness of developed structure and function of the body and/or mind; it is an absence of health.
- may produce a difficulty with functioning, normal growth and development and preventing or controlling disease and disability and their effects.
- is an objective dysfunction which can be diagnosed and treated by health care providers.
The nurse promotes physical health and wellness by:
- providing assistance with activities of daily living
- safely administering medications and parenteral therapies (PHARMACOLOGICAL THERAPEUTICS)
- reducing the risk that patients will develop complications of health problems, treatments or procedures
- providing and managing care of patients with acute, chronic and /or life threatening health conditions
- incorporating the principles of growth and development into patient care
- promoting health through the use of prevention and early detection health programs
The environment is an open, evolving system that consists of internal and external factors, physical, psychological, social , cultural and spiritual, that influence or affect the life and survival of a person or community. The person constantly interacts and communicates with the environment. Physical, psychological, socio-cultural and spiritual dimensions create a dynamic relationship between the changing environment and health. The nurse achieves client outcomes by providing a safe and effective health care environment in order to protect clients, families/significant others, communities and other health care personnel. Environmental conditions:
- Can be altered in light of a person’s special needs, age related needs, and the changes being sought in the person’s health state or manner of living
- Contribute to personal growth when sufficient resource are available
- Is an art and applied science;
- Applies principles from the physical, social and behavioral sciences, nursing research, nursing theory and past nursing experiences;
- Is a dynamic profession which is an integral part of health care services in the community;
- Values integrity, ethical practice, diversity, life-long learning, service and quality;
- Includes caring, which is a state of mind of an individual characterized by concerns for, interest in, and solicitude for another;
- Adheres to standards of professional practice and practices within legal, ethical and regulatory frameworks;
- Effectively utilizes human, physical, financial/cost effective and technological resources to meet patient needs, provide safe, quality patient care, and support organizational outcomes;
- Utilizes the nursing process for knowledgeable decision making and judgment based on critical thinking, clinical competence, collaboration and accountability and evidenced-based practice;
- Determines the relationship between self-care demand and self-care ability;
- Designs systems to compensate for a person’s total inability to engage in self-care, assists in performance of some self-care activities, and/or provides education and support to increase self-care abilities;
- Acts as a patient advocate by initiating needed changes to improve outcomes and provide the patient with the opportunity to make informed decisions;
- Develops goals towards health promotion which empower individuals toward self-care;
- Involves an interpersonal relationship between the nurse and patient which establishes a social contract to provide care characterized by caring and communication;
- Operates within roles that are provider of care, manager of care and member of the nursing profession;
- Promotes attainment of positive outcomes and the highest level of health and wellness of individuals, families groups and communities throughout the developmental lifespan;
- Includes collaboration with the patient, significant support person(s), peers, other members of the health care team and community agencies;
- Has at its core primary, secondary, and tertiary prevention of illness or the response to illness;
- Roles (clinician, advocate, manager, teacher, health policy creator and promoter, quality controller and assuror, and protector) are perpetuated by the nursing process.
Provider of Patient - Centered Care (Nursing):
- The professional nurse provides nursing care to individuals, families, groups, and communities along a continuum of health and illness in multiple settings through the nursing process, nursing skill proficiencies, and nursing interventions. Using the nursing process, the nurse is concerned with assessing health, illness and the response to disease as well as the relationships among these three. The nursing process is a problem solving process based on the scientific method. it serves as an organizational framework for the practice of professional nursing in the areas of health maintenance and promotion, acute illness intervention, and rehabilitation, and chronic care management. The five important phases of the nursing process are (1) Assessment, (2) Diagnosis, (3) Planning, (4) Implementation, and (5) Evaluation. These phases are interrelated and dependent upon one another. Application requires a strong knowledge base in physical, behavioral and social sciences.
- Nursing interventions require a commitment to caring. They focus on preventing illnesses, promoting health, and maximizing physical, functional, and psychosocial status. These interventions require clinical judgment skills; diagnostic and monitoring skills; and helping, coaching, teaching and counseling skills. This nursing judgment helps the nurse make practice decisions based on observation and interpretation of evidence, but also considers patient preferences, values and needs and engages patients as active participants in promoting health, safety, well-being and self-care management. Therefore, nurses develop a spirit of inquiry that informs their nursing practice, allows them to question and offer new ideas to improve the quality of care. The nurse collaborates with the health team and the patient in planning, decision making, problem solving, goal setting and assumption of responsibilities in an effort to work cooperatively together to achieve quality patient-centered care and advocate for the patient's ongoing growth (human flourishing)..
Member of the Profession (Nursing):
- The nurse develops an understanding of the professional role (Professional Identity) that reflects integrity, responsibility for patients, health team members and the health care organization, ethical practices, and a commitment to evidence -based practice
- The nurse as a member of a profession is responsible and accountable for quality patient care in the clinical setting.
- The nurse substantiates clinical decision making (nursing judgment) with knowledge and research findings using critical thinking and evidence-based practice to the changing health care environment.
- Nurses are aware of ethical and legal standards of professional practice; and contributes to the profession through membership in professional organizations.The professional nurse is committed towards developing an expert practice base and remains current through knowledge of the issues and trends affecting the nursing role and health care delivery.
- As a member of the profession, the nurse collaborates and negotiates change with other team members. The nurse serves as a patient advocate.
- The nurse establishes goals for professional development and accepts responsibility for life long learning (a spirit of inquiry) that lays the foundation for a practice based on evidence, best practices and patient values. The goal is to achieve self-fulfillment and self-actualization(human flourishing).
Manager of care (Nursing):
- The nurse is involved in organizing and facilitating the delivery of comprehensive, efficient and appropriate service to individuals, families, groups, and communities. The coordinator of care is aware of the complexity of human and material resource allocation as she/he collaborates with patients, their support systems, and a variety of providers to support and monitor organizational outcomes using skilled communication and information technology. The nurse manager learns to value technologies and information management systems that support effective clinical decision making (nursing judgment), error prevention and care coordination. For near misses and errors the nurse participates in root cause analysis rather than blame to reduce risk of harm to patients and providers.
- While planning and coordinating care the nurse addresses the total continuing health needs of the patient and the impact of legal and ethical aspects of care. Delivery of care is based on staffing models, and on the use of principles of delegation to improve efficiency and productivity.
- Nurses seek information about outcomes of care and use quality improvement processes and tools to provide safe patient care and improve the quality and safety of the health care system through collaborative nursing and inter-professional teams.
- Nurse managers build a culture where teamwork is valued for its positive impact on safety, quality of care, recognition of change and uncertainty in complex health care environments, and learn to influence health care policy through professional role commitment and participation.
- Planning, organizing, directing, coordinating and controlling skills, thought fundamental to nursing, require ongoing practice and experience. Therefore, nurses promote self-actualization and self-fulfillment as a nurse manager/coordinator of care (human flourishing) while making management decisions based on critical thinking and integration of best evidence into the management role.
Nursing Process: (Nursing)
The nursing process provides a systematic platform for critical thinking in nursing practice which guides nursing actions and involves assessing, diagnosing, planning, implementing and evaluating through:
- Ongoing assessment of the patient’s universal and developmental self-care demands and health deviations, utilizing multiple resources;
- Identification of the patient’s self-care deficits (nursing diagnoses);
- Establishment of patient outcomes to prevent illness, meet the patient’s self-care demand, restore health, move the patient toward independent self-care, adaptation to self-care interruptions/declines, or transfer responsibility to family or significant others within a variety of health care settings;
- Identification and implementation of nursing measures; preventive, (educative-supportive) or restorative (wholly/partially compensatory) through action, guidance, support, teaching and providing a developmental environment;
- Evaluation of outcomes with modification of nursing actions as appropriate.
The individual, family , group and community collaborates throughout each step of the nursing process ensuring that the plan and implementation of care is unique to their health needs.
Critical thinking (Nursing):
Critical thinking within the curricula is needed to prepare practitioners capable of the autonomy and level of thinking required in an increasingly complex health care environment. Critical thinking is about learning to learn, to think for yourself, on your own and in collaboration with others. Critical thinking leads us away from naïve acceptance of authority and towards independent professional decision making. The faculty at Ventura College School of Nursing defines critical thinking as:
“Critical thinking is that mode of thinking--- about any subject, content, or problem--- in which the thinker improves the quality of his or her thinking by skillfully taking charge of the structures inherent in thinking and imposing intellectual standards upon them. Critical thinking is, in short, self-directed, self-disciplined, self-monitored, and self-corrective thinking. It presupposes assent to rigorous standards of excellence and mindful command of their use. It entails effective communication and problem solving abilities and commitment to overcome our native ego-centrism and socio-centrism.” (Paul, 1999)
“Critical thinking is a rational investigation of ideas, inferences, assumptions, principles, arguments, conclusions, issues, statements, beliefs, and actions that covers scientific reasoning and includes the nursing process, decision making and reasoning in controversial issues.” (Bandman & Bandman, 1995) Critical thinking is the ability to analyze, prioritize, and synthesize information.
A well cultivated critical thinker:
- Raises vital questions and problems, formulating them clearly and precisely;
- Gathers and assesses relevant ;information, using abstractions to interpret it effectively;
- Comes to well-reasoned conclusions and solutions, testing them against relevant criteria and standards;
- Thinks open-mindedly within alternative systems of thought, recognizing and assessing, as need be, their assumptions, implications, and practical consequences;
- Communicates effectively with others in figuring out solutions to complex problems; and
- Evaluates whether certain conclusions necessarily follow from the information in given statements or premises." (Paul, 1999; and Watson & Glaser, 2000).
Evidence Based Practice(Nursing):
Nurses use evidence-based practice (EBP) to guide their critical thinking. Evidence-based practice is the conscientious, explicit and judicious use of the current best evidence possible in making clinical decisions about the care of individual patients. Evidence-based practice values, enhances and builds on clinical expertise, knowledge of disease mechanisms, pathophysiology, and best available evidence. It involves complex and conscientious decision making based not only on the available evidence but also on patient characteristics, situations, preferences and values. It recognizes that health care is individualized and ever changing and involves uncertainties and probabilities. Ultimately evidence-based practice is the formalization of the care process that the best clinicians have practices for generations. <Adapted from Mc Kibbon, (1988), Bulletin of the Medical Library Association 86 )3); 396-401>. "EBP improves student knowledge, skills and behavior, such as: asking questions, searching for evidence, and applying critical appraisal techniques that influence and direct nursing practice." (Stevens & Cassidy, 1999, Cheever, 2010).
Nurses use EBP to solve problems by:
- Identifying the problem based on analysis of current nursing knowledge and practice, that is, learning how to ask clinical questions that can be addressed by existing literature and developing skills in finding and critically appraising the evidence;
- Searching the literature for relevant information to this setting including best practices, research, and standards of care;
- Reviewing the evidence using clinical reasoning resulting in evidence based knowledge regarding the problem and nursing practice. The various issues that must be considered in the use of evidence-based practice include:
- Patient population characteristics, including culture, socioeconomic status, and the existence of other health and social issues that may complicate service delivery (e.g. pregnancy, incarceration, disabilities);
- Staff attitudes and skills required by EBP;
- Facilities and resources required by EBP;
- Agency policies and administrative procedures needed to support EBP;
- Inter agency linkages or networks to provide needed additional services (e.g. vocational, educational, housing assistance, etc);
- State and local regulations;
- Reimbursement for the specific services to be provided under EBP.
- Transforming knowledge into practice by:
- Specifying expected outcomes;
- Choosing interventions;
- Justifying the selection with evidence, and;
- Evaluating outcomes and modifying nursing practice (Stevens & Cassidy, 1999, Tanner, 2008, Cheever, 2010).
- Have individual learning needs, learning styles, readiness, support systems, cultural and ethnic backgrounds
- With the assistance of the faculty, assume accountability/responsibility to fulfill the learning objectives utilizing a variety of resources
- Are adult learners who will be able to utilize the process of self-evaluation as a tool in moving from dependence to independence
- Develop professional behaviors that benefit other students and the community
Program Student Learning Outcomes
Graduates of the Ventura College ADN Program will demonstrate the three roles of the nurse: Member within the Discipline of Nursing; Provider of Care, and Manager of Care (NLN Roles and Competencies 2000). These three roles are the Program Student Learning Outcomes that have guided the development of the curricular structure, course student learning outcomes, learning experiences, and competencies. Evidence that graduates have learned the knowledge, skills and ethical basis for nursing practice is not only reflected in student accomplishment of level competencies, but also:
- Performance on the NCLEX licensure examination
- Program completion
- Program satisfaction
- Job placement
The graduate will demonstrate the following Program Student Learning Outcomes:
- Operate within the role as Member Within the Discipline of Nursing by demonstrating and fostering high standards of nursing practice.
- Operate within the role as Provider of Care by providing competent and safe care in a variety of settings to a group of patients with diverse self-care needs across the life span by utilizing the nursing process for knowledgeable decision making and judgment based on critical thinking, clinical competence, collaboration and accountability.
- Operate with the role as Manager of Care by demonstrating management and leadership in providing care to a group of patients with complex and diverse needs.