The faculty has identified four theoretical components as the basis of this curriculum: person, environment, health and nursing. From these components evolve the strands which run throughout the curriculum: critical thinking, evidence-based practice, communication, human development, nursing process, professionalism and caring. Our conceptualization of nursing practice is derived from these components.
A person is seen as a holistic individual striving to adapt to changes within internal and external environments. Positive and negative factors influence how the person responds to changes in each environment. The relative strength of these positive and negative factors determines the person’s position on the adaptation-maladaptation continuum. This continuum varies from individual to individual through different stages of development throughout the lifespan.
Methods the person uses to facilitate adaptation, and thereby attain an optimal state of health, are based upon the theory of the problem-solving process. The goal of the nurse, then, is to aid the person to reach an optimal state of health through adaptation to changes in his/her environments.
The internal environment is the person’s inner response to factors which threaten his/her adaptation. The person’s external environment is composed of factors which have an outside influence on the person’s capacity to maintain an optimum state of health on the adaptation-maladaptation continuum.
Since the person is viewed holistically, his/her internal and external environments are as follows:
Physiological: structure and function of the body systems. These systems are: neurological (sensory), cardiovascular, respiratory, gastrointestinal, musculoskeletal, integumentary, hematopoietic/immune, endocrine, reproductive, and renal.
Ecological: physical surroundings in which the person exits: shelter, climate, urban/rural and occupational settings, economic and epidemiological concerns.
Sociocultural: structure and function of interactive systems: such as health care, educational, political, groups (i.e. family and community) and diverse cultures.
Psychological: personality, feelings, cognitive functioning, and interpersonal relationships.
Spiritual/philosophical: philosophical issues, values, ethical beliefs, spirituality and religious beliefs, and movement toward self-actualization.
It must be recognized that the environments are interrelated and that changes in one will affect other environments as well.
Health is a dynamic process of being and becoming an integrated holistic individual by continuously adapting to change. An assessment of health needs and problems at both the individual, family and community levels reveals certain individuals and groups to be at risk of illness or injury, or in need of health and nursing care to promote and maintain health and prevent illness. Health and illness are seen as a continuum that parallels the adaptation-maladaptation continuum. In this conceptual framework, health is synonymous with adaption, and illness is synonymous with maladaptation.
Nursing is a caring, scientific, practice discipline. The goals of nursing are to facilitate adaptation and to promote and maintain system integrity, with the ultimate goal of assisting each individual, family or community to reach an optimal state of health. The professional nurse works autonomously and collaboratively in these efforts.
The nurse utilizes the nursing process to facilitate adaptation to changes in each environment. When using the nursing process, the professional nurse fulfills one or more of elements of the nursing role: care-giver, advocate, leader, counselor, educator, coordinator, collaborator, consultant, change agent, and researcher. The professional nurse also supervises and coordinates the care given by others.
Teaching-learning theory is utilized throughout the curriculum to assist the learner to attain the program’s objectives. A caring environment is provided in which the student feels supported as the student progresses from learner to professional practitioner. Individual differences are acknowledged by determining the learner’s knowledge level, providing a variety of learning modes and experiences, and by allowing the learner to participate in choosing learning experiences to meet their individual needs. Learning has been achieved when there has been application of knowledge and skills by the learner. The success of teaching-learning is the joint responsibility of the individuals involved in its planning, implementation, and evaluation.
The strands that evolve from the conceptual framework components and are integrated throughout the curriculum are:
Critical Thinking: the formulation of decisions and judgments using a composite of cognitive skills, attitudes and knowledge which are goal-directed, ethically founded. Critical thinking is the ability to critique a plan of care, demonstrate a willingness to search for solutions to problems, and utilize an inquisitive nature in the acquisition of knowledge. A critical thinker demonstrates the ability to “identify central issues and assumptions in an argument, recognize important relationships, make correct inferences from data, deduce conclusions from information or data, interpret whether conclusions are warranted on the basis of the data given, and evaluate evidence or authority.” (Pascarella, E.T. & Terenzini, P.T., (1991). How College Affects Students: Findings and Insights from Twenty Years of Research, p 118).
Evidence-based practice: the integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making (Sackett, Straws, Richardson, Rosenburg & Haynes; 2000).
Communication: an interactive process of exchanging ideas, thoughts, information, or feelings between two or more people. The intent of any communication is to elicit a response. It is a basic component of human relationships and may be verbal or nonverbal. Nurses who communicate effectively are better able to initiate change that facilitates adaptation and promotes development of trusting relationships.
Human Development: a dynamic process resulting in biological and physiological advances and changes throughout the life cycle. The rate and timing of these advances and changes are highly individualized and fall within common categories or boundaries. Development involves these changes through constant interaction with the environment. It follows certain psychosocial, cognitive and moral tasks which occur progressively from the simple to complex, which may overlap and/or change simultaneously.
Nursing Process: a cognitive process which facilitates the person’s adaptation to changes in each environment through the nurse’s use of critical thinking, creative problem-solving, and efficient and accurate decision-making. It is flexible and adaptable, yet sufficiently structured to provide a base for nursing actions. The nursing process is a systematic, cyclic procedure that provides the framework for nursing practice in a variety of settings. The nurse utilizes the nursing process to develop and implement nursing interventions which promote, maintain, and restore the health of individuals, families, and communities.
The nursing process consists of five steps which are sequential, but often overlapping:
assessing - gathering data through observation, communication, and examination
analyzing - evaluating data to determine actual or potential problems in adaptation; developing nursing diagnoses, and establishing patient-centered goals
planning - developing and prioritizing planned nursing actions by which the nurse can facilitate man’s adaptation
implementing - carrying out planned nursing actions
evaluating - gathering data to determine if nursing actions were effective in meeting patient goals
Professionalism: a socialization process by which an individual acquires the beliefs, values, attitudes, and behaviors of the discipline of nursing. The professional nurse evaluates his/her nursing practice, seeks professional growth through lifelong learning and involvement in professional organizations, and is accountable and responsible for his/her behavior.
Caring: the practice of providing an environment which integrates knowledge and skills with growth producing attitudes and behaviors. These behaviors are based on compassion, hope, encouragement, sensitivity and acceptance of individual differences and needs. Caring behaviors encourage the development of the maximum potential without judgment of individuals, families and communities.
The future role of the nurse will be expanded to include increased emphasis on health maintenance and promotion. New roles will continue to evolve due to increased acuity in community and hospital settings and in keeping with societal changes. Self care and client participation in nursing and health care will be increasingly expected by consumers and providers of health care. Changes in cost containment and reimbursement will continue to affect meeting the health care needs of the individual, family and community.
Expanding scientific technology will continue to require nurses to develop expertise in using new equipment and techniques and to gain an understanding of the person’s responses to them. The challenge to nurses will be to maintain the humanness and caring elements of the nurse’s role in the delivery of health care in an increasingly technological environment.
The future of nursing is intertwined with many aspects of society, such as legislation, economics and health care delivery. The professional nurse must think critically and creatively in order to cope with the ever-expanding fields of knowledge and must accept responsibility for personal adaptation to change. The basic knowledge and preparation for this role is the responsibility of baccalaureate nursing education in cooperation with other health agencies and governing bodies.
Udpated: May 2009