INTRODUCTION

The Nursing Department at Broome Community College equips graduates with basic nursing skills and knowledge which they need to function effectively as providers of care, managers of care and members of the discipline of nursing. The program provides education in nursing practice as defined by nurse practice acts and by professional standards of nursing practice.

The philosophy of the Nursing Department is consistent with the mission of Broome Community College. The philosophy incorporates faculty beliefs regarding nursing, person, health, environment, life cycle, nursing education, the teaching/learning process and associate degree nursing practice. These components are addressed as a whole rather than separated into parts, thus emphasizing the interrelationship of the elements.

Program objectives for the graduate of the nursing program are consistent with the goals of the general education program at Broome Community College. The organizing structure of the nursing curriculum is described as it evolves from the philosophy and program objectives.

PHILOSOPHY

Nursing is the process of human caring which facilitates health and healing in persons and society. The essence of nursing practice is the caring behaviors in which the nurse engages within the context of the nurse-client relationship. Nursing practice is firmly grounded in fundamental clinical and technological competencies as well as the sciences and humanities.

Each person possesses three spheres: mind, body, and soul. Together these entities comprise a unique, integrated human being. Persons have human needs which must be met in order to relieve distress or to improve well-being. These needs exist in a hierarchical fashion, as identified by Maslow. Throughout the life cycle, nursing assists persons with satisfying human needs in order to promote health and facilitate growth and development. Basic human needs can best be understood by organizing them into a structural system based on Gordon's Functional Health Patterns.

The dignity and worth of all persons is recognized. Their right to autonomy and freedom of choice in the process of human caring and healing is acknowledged.

Health is unity and harmony within the mind, body and soul. Health does not presume the absence of disease, and illness is not necessarily disease. Since health is considered harmony, illness is disharmony within the person. Health is determined by a person's perception of well-being (harmony) with others and the environment.

The health-healing environment includes the physical, mental, socio-cultural, and spiritual aspects of a person's domain. Persons are affected by the environment and by their unique responses to that environment. Nursing has the responsibility to assess those individual responses and to provide supportive, protective or corrective modifications to the environment.

Society is made up of persons with various values, beliefs, traditions, norms and rules which reflect their respective cultures. Culturally diverse persons are a part of, and interrelate with, society at large. In order to interact effectively with all persons, nursing care must be in harmony with individual cultures.

Nursing (as both an art and a human science of health experiences) includes professional, personal, scientific, aesthetic, and ethical interactions. These nursing interactions are the essence of the caring process which occurs through the nurse's unique use of self in helping to restore a person's inner harmony, self-knowledge and control. The nursing process (which includes knowledge of physical, biological, behavioral and social sciences) is used to plan nursing care. The art and science of nursing is focused on the person's perception of harmony and on assisting the person to preserve, restore or strengthen inner harmony.

The agent of change is the person's internal mechanisms that allow the self to be healed. Self-healing can be facilitated through various external means (e.g. therapeutic measures). The nurse is a co-participant in the healing process.

Nursing education should prepare the student to function as a member of the health care team in primary, secondary, and tertiary levels of illness prevention. As a team member, the nurse is responsible for providing competent and compassionate care, and for collaborating with other members of the health care team to manage care in a variety of settings (community and traditional institutional facilities).

Nursing education should take place in an academic environment and be supported by biological and social sciences, as well as by liberal arts. Nursing faculty must develop the student's awareness of cultural similarities and differences as well as global issues which impact the present and future trends in health care. Students have opportunities to participate in campus-wide academic, social and recreational activities and community projects which complement their educational program. Supportive strategies are planned to assist students in realizing their student and career goals. Faculty provide learning experiences with persons who have health care needs appropriate to the student's level of expertise. The student has the responsibility to grow and to discover wisdom from within. This is facilitated by caring guidance of the faculty and a variety of campus support services.

Teaching is the process of empowering students to develop critical thinking skills. This allows them to incorporate previous learning, conceptualize unfamiliar events, understand problems, determine their significance, and design innovative solutions. We believe each learner is unique and that learning takes place as a continuous process throughout the life cycle. The focus of learning is on clinically grounded experiences that are analyzed, reflected upon, synthesized and understood. An essential component of learning is cooperation and participation with others, but students are ultimately responsible for their own learning. Students and faculty are expected to accept mutual responsibility for developing a permanent spirit of inquiry and commitment to learning.

An effective teaching-learning process is dependent upon the teacher's ability to be a catalyst in the student's search for understanding and integration of concepts. Success in learning the art and science of nursing depends on the student's ability to apply the central concepts of caring while implementing the nursing process.

The nurse with an associate degree participates in the diagnosis and treatment of human responses to actual or potential health problems through such services as casefinding, health teaching and health counseling. The nurse provides care supportive to, or restorative of life and well-being to individuals within the context of their support system. Such services are provided in collaboration with other members of the health care team and in keeping with established standards of nursing practice. The associate degree graduate practices within appropriate legal and ethical parameters while integrating teaching and communication as integral dimensions of the role.

NURSING PRACTICE ROLES

The eight nursing practice roles of the Associate Degree Nurse are implemented throughout the curriculum. These roles come from the Educational Competencies for graduates of Associate Degree Nursing Programs developed by the National League for Nursing Council of Associate Degree Nursing Competencies Task Force (2000).

Professional Behaviors: Professional behaviors within nursing practice are characterized by a commitment to the profession of nursing. The graduate of an associate degree nursing program adheres to standards of professional practice, is accountable for her/his own actions and behaviors, and practices nursing within legal, ethical, and regulatory frameworks. Professional behaviors also include a concern for others, as demonstrated by caring, valuing the profession of nursing, and participating in ongoing professional development.

Communication: Communication in nursing is an interactive process through which there is an exchange of information that may occur verbally, non- verbally, in writing, or through information technology. Those who may be included in this process are the nurse, client, significant support person(s), other members of the healthcare team, and community agencies. Effective communication demonstrates caring, compassion, and cultural awareness, and is directed toward promoting positive outcomes and establishing a trusting relationship.

Therapeutic communication is an interactive verbal and non-verbal process between the nurse and client that assists the client to cope with change, develop more satisfying interpersonal relationships, and integrate new knowledge and skills.

Assessment: Assessment is the collection, analysis, and synthesis of relevant data for the purpose of appraising the client's health status. Comprehensive assessment provides a holistic view of the client which includes dimensions of physical, developmental, emotional, psychosocial, cultural, spiritual, and functional status. Assessment involves the orderly collection of information from multiple sources to establish a foundation for provision of nursing care, and includes identification of available resources to meet client needs. Initial assessment provides a baseline for future comparisons that can be made in order to individualize client care. Ongoing assessment and reassessment are required to meet the client's changing needs.

Clinical Decision Making: Clinical decision making encompasses the performance of accurate assessments, the use of multiple methods to assess information, and the analysis and integration of knowledge and information to formulate clinical judgments. Effective clinical decision making results in finding solutions, individualizing care, and assuring the delivery of accurate, safe care that moves the client and support person(s) toward positive outcomes. Evidence based practice and the use of critical thinking provide the foundation for appropriate clinical decision making.

Caring Interventions: Caring interventions are those nursing behaviors and actions that assist clients in meeting their needs. These interventions are based on a knowledge and understanding of the natural sciences, behavioral sciences, nursing theory, nursing research, and past nursing experiences. Caring is the "being with" and "doing for" that assist clients to achieve the desired results. Caring behaviors are nurturing, protective, compassionate, and person-centered. Caring creates an environment of hope and trust, where clients choices related to cultural values, beliefs, and lifestyle are respected.

Teaching and Learning: Teaching and learning processes are used to promote and maintain health and reduce risks, and are implemented in collaboration with the client, significant support person(s), and other members of the healthcare team. Teaching encompasses the provision of health education to promote and facilitate informed decision making, achieve positive outcomes, and support self-care activities. Integral components of the teaching process include the transmission of information, evaluation of the response to teaching, and modification of teaching based on identified responses. Learning involves the assimilation of information to expand knowledge and change behavior.

Collaboration: Collaboration is the shared planning, decision making, problem solving, goal setting, and assumption of responsibilities by those who work together cooperatively, with open professional communication. Collaboration occurs with the client, significant support person(s), peers, other members of the healthcare team, and community agencies. The nurse participates in the team approach to holistic, client-centered care across healthcare settings. The nurse functions as advocate, liaison, coordinator, and colleague as participants work together to meet client needs and move the client toward positive outcomes. Collaboration requires consideration of client needs, priorities and preferences, available resources and services, shared accountability, and mutual respect.

Managing Care: Managing care is the efficient, effective use of human, physical, financial and technological resources to meet client needs and support organizational outcomes. Effective management is accomplished through the processes of planning, organizing, directing, and controlling.

The nurse, in collaboration with the healthcare team, uses these processes to assist the client to move toward positive outcomes in a cost effective manner, to transition within and across healthcare settings, and to access resources.

BROOME COMMUNITY COLLEGE DEPARTMENT OF NURSING

PROGRAM OUTCOMES Required Outcomes:

1. Performance on NCLEX Examinations: The average pass rate will be +/- 2 of the New York State average annually for first time takers.

2. Employment Rates: a. 90% of graduates seeking employment will be employed within 1 year after graduation.

3. Graduation Satisfaction with Program: 90% of graduates will rate overall program satisfaction at a level average or above average.

4. Employer Satisfaction with Graduates: 90% of employers will rate overall program satisfaction at a level average or above average.

5. 65% of students will graduate from the nursing program within 4 years of entering the program.

ORGANIZING FRAMEWORK

The components of the organizing framework of the nursing curriculum are: Gordon's Functional Health Patterns, the nursing process and life cycle. The organizing framework operationalizes the program philosophy.

GORDON'S FUNCTIONAL HEALTH PATTERNS

Gordon's Functional Health Patterns include: Health-Perception and Health-Management - client's perceived pattern of health and well-being; how health is managed (primary, secondary and tertiary levels of illness prevention) Nutritional-Metabolic - pattern of food and fluid consumption relative to metabolic need; pattern indicators of local nutrient supply; skin integrity and thermoregulation Elimination - patterns of excretory function (bowel, bladder) Activity-Exercise - pattern of exercise, activity, leisure, recreation, cardiac and respiratory function Sleep-Rest - patterns of sleep, rest, and relaxation Cognitive-Perception - sensory perceptual and cognitive pattern (how well a client perceives stimuli and interacts with the environment) Self-Perception and Self-Concept - self-concept patterns (e.g., body comfort, body image, feeling state); perceptions of self (e.g., body image, self-esteem, personal identity)

Role-Relationship - pattern of role-engagements and relationships (e.g. developmental levels) Sexual-Reproductive - patterns of satisfaction and dissatisfaction with sexuality pattern; reproductive patterns Coping-Stress Tolerance - general coping pattern, effectiveness of the pattern in terms of stress tolerance Value-Belief - patterns of values, beliefs (including spiritual); goals that guide choices or decisions (culture and concepts of caring) Each pattern is introduced in the first nursing course and is applied to normal human functioning. Disharmony (disruptions) in normal functioning are discussed and analyzed in subsequent nursing courses. Each of these courses emphasizes specific disharmony (disruptions) in human functioning. At the same time, each course incorporates the entire scope of functional patterns so that a holistic view is maintained.

NURSING PROCESS

The nursing process is the foundation of nursing practice. Therefore, it is an integral component of the organizing structure of the curriculum. This process uses critical thinking skills and a broad knowledge base to ensure humanistic and holistic care of each client. The nursing process is a problem solving method used to develop plans of care which provide consistent and responsible nursing management of human needs.

The Broome Community College curriculum incorporates assessment, nursing diagnosis, planning, implementation and evaluation as the five steps of the nursing process. Assessment - the act of collecting and organizing information relevant to client needs. Nursing diagnosis - actual or potential need evolving from data analysis that requires nursing intervention for resolution. The nursing diagnosis includes the causative factor(s).

Planning - the determination of the measurable goal(s) to resolve the nursing diagnosis. The nurse and client collaborate in planning goals and actions designed to resolve client needs.

Implementation - actions taken to help the client attain the defined goal(s)

Evaluation - appraisal of goal achievement and reassessment of the plan of care.

LIFE CYCLE

The life cycle reflects the stages of growth and development from conception through life to death. Because an individual must proceed through developmental stages, and because these stages are a dynamic process, the client's current life cycle stage is an integral component of the nursing process.

GLOSSARY DISHARMONY - a disruption in human functioning or an incongruence within the mind, body and soul. Disharmony is associated with illness, but not necessarily disease. Disease can result from disharmony and illness, and disease can in turn create more disharmony.

HARMONY - congruence between the self as perceived and the self as actually experienced or external reality. Harmony is associated with health.

HUMAN CARING - an art and a science by which nurses assist other human beings to reach self-actualization, maintain or attain health, or die a peaceful death. This process is demonstrated through a therapeutic interpersonal relationship and incorporates such dimensions as: Respect - a courteous regard for another (e.g., listening to client's concerns, planning care in collaboration with client, addressing client by preferred name). Presence - an investment in the other's needs and security (e.g., using silence, helping persons deal with their feelings, responding quickly to client's call). Connectedness - an optimistic and constant readiness on the part of the nurse to help others (e.g., being cheerful with client, being hopeful with client, using touch therapeutically). Knowledge - being proficient, informed and skillful (e.g., giving skilled care, maintaining client safety, teaching self-care). Attentiveness - an appreciation of and involvement in the other's perspective and experience (e.g., being available when needed, paying attention when the client is talking, showing concern).

LEVELS OF ILLNESS PREVENTION Primary prevention of the occurrence of disease (e.g., immunizations, car seat restraints, asepsis). Secondary - detection and prompt treatment of disease to prevent or limit disease (e.g., physical assessments, pregnancy testing, breast and testicular examinations). Tertiary - prevention of disability, complications, and death from disease (e.g., rehabilitation, support groups, diabetic health education).

BIBLIOGRAPHY

Council of Associate Degree Nursing Competencies Task Force NLN (2000). Educational competencies for graduates of associate degree nursing programs. Sudbury, Mass: Jones & Bartlett Publishers.

Craven, R. & Hirnle, C. (2007), 6th Edition, Fundamentals of nursing: human health and function. Philadelphia: J. B. Lippincott.

Gordon, M. (1987). Nursing diagnosis: process and application, 2nd edition. New York: McGraw-Hill.

Maslow, A. (1968). Toward a psychology of being, 2nd edition. New York: D. Van Nostrand.

Smith, C. & Maurer. F. (1995). Community health nursing. Philadelphia: W. B. Saunders.

Watson, J. (1988). Nursing: human sciences and human care. New York: National League for Nursing.