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TRINITY VALLEY COMMUNITY COLLEGE ASSOCIATE DEGREE NURSING PROGRAM PHILOSOPHY The mission and philosophy of the Associate Degree Nursing (ADN) Program support the mission and purposes of Trinity Valley Community College (TVCC) by helping students realize their educational goals in nursing. Successful completion of the associate of applied science degree curriculum leads to acquisition of skills, knowledge and attitudes necessary for employment, thereby helping to meet the health care needs of the community served by TVCC. We believe nursing is both an art and a science which integrates concepts from the liberal arts and the biological, psychological and social sciences to form a common focus: improving the health of people from diverse communities, in a caring, culturally sensitive manner. Caring includes forming relationships with individuals/ families in compassionate, nurturing, protective, empathetic, nonjudgmental, open-minded and altruistic ways. As a scientifically based discipline, nursing collaborates with individuals/ families and the multidisciplinary team to assist in meeting health care needs. Nursing is dynamic and evolving, and includes health promotion, health restoration, and health maintenance, as well as providing care to dying people so that they have a peaceful, dignified death. Nurses contribute to health care activities across a continuum consisting of primary, secondary, and tertiary prevention. Nurses provide competent, safe care by utilizing the tools of critical thinking, which include the nursing process: assessment, analysis, planning, implementation, and evaluation, diagnostic reasoning, making clinical inferences, and clinical decision-making. The nursing process is administered through the four roles of the associate degree nurse: provider of patient-centered care, patient safety advocate, member of the health care team, and member of a profession. The nurse incorporates a professional, accountable, legal, and ethical framework into their nursing practice to empower individuals to take charge of their own state of health. As a client advocate, the nurse actively supports the welfare of the client through personal and professional actions and interactions with others. As a change agent, the nurse is a proactive and reactive practitioner who acts to modify and improve current health care by using evidenced based practices. The practice of nursing includes a commitment to people and the community in which they live as well as to the society and the environment encompassing the individuals. The nursing education curriculum prepares the graduate to provide community-based, community-focussed health care. The associate degree nurse collaborates with licensed vocational nurses, baccalaureate prepared nurses, and 2 masters prepared nurses as well as other disciplines to empower clients and their families to attain and maintain an optimal level of wellness. We believe learning is a dynamic process based on life experiences, ability to learn, and readiness to learn. Learning is most effective when the learner is an active participant in setting goals, and evaluation of learning experiences and competency. Complex concepts build upon previous knowledge and experience. We believe learning is a partnership between the instructor and the learner which encourages intellectual curiosity and the capacity for self-direction. The instructor assists the learner by creating a learning-centered environment utilizing a variety of teaching strategies. Quality learning is enhanced with greater engagement within the student learning community. This community consists of learning experiences in the classroom, skills lab, and the interdisciplinary health care system that serve as motivational forces for life-long learning. MISSION STATEMENT Our mission is to prepare graduate nurses who use critical thinking to provide safe, competent health care, who are ethically-guided and culturally sensitive client advocates, who collaborate with the multidisciplinary health care team in an ever-changing environment, and who provide compassionate nursing care throughout the community in traditional and nontraditional settings. PROGRAM OBJECTIVES PROVIDER OF CARE The graduate will: 1. Provide comprehensive nursing care to patients and their families. 2. Determine the health status and health needs of clients and their families based upon interpretation of health related data and evidence-based health practices. 3. Formulate goals/outcomes and plans of care for patients and their families using established best practices in collaboration with the patient, their family, and multidisciplinary health care team. 4. Implement plan of care within legal, ethical and regulatory parameters and in consideration of client factors. 5. Develop and implement teaching plans for patients and their families to address health restoration, maintenance, and promotion. 6. Evaluate patient outcomes and responses to therapeutic interventions. 7. Use the nursing process and critical thinking to analyze clinical data and current literature as a basis for decision making in nursing practice. 3 8. Coordinate human and material resources for the provision of care for patients. PATIENT SAFETY ADVOCATE The graduate will: 1. Demonstrate knowledge about the Texas Nursing Practice Act and Board Rules. 2. Implement measures to promote a safe environment for patients and others. 3. Obtain instruction, supervision or training as needed when implementing nursing procedures or practices. 4. Know, recognize and maintain professional boundaries of the nurse-patient relationship. 5. Comply with mandatory reporting requirements of the Texas Nursing Practice Act. 6. Understand the concept of “scope of practice” and function within individual scope of practice. 7. Accept and/or make assignments that take into consideration patient safety and that are commensurate with educational preparation and employing health care institutional policy. COORDINATOR OF CARE The graduate will: 1. Collaborate with patients, families, and the multidisciplinary health care team for the planning, delivery, and evaluation of care. 2. Refer patients and their families to resources that facilitate continuity of care and health promotion. 3. Function within the nurse’s legal scope of practice and in accordance with the policies and procedures of the employing health care institution. 4. Communicate and collaborate in a timely manner with members of the multidisciplinary health care team to promote and maintain the patient’s optimal health status. 5. Assign and/or delegate nursing care to other members of the health care team as needed. 6. Supervise nursing care provided by others for whom the nurse is responsible. MEMBER OF A PROFESSION The graduate will: 1. Assume responsibility and accountability for the quality of nursing care provided to patients. 2. Serve as a health care advocate in monitoring and promoting quality and access to health care for patients. 4 3. Participate in activities that promote the development and practice of professional nursing. 4. Demonstrate responsibility for one’s own continued competence in nursing practice and professional growth. The Program Objectives are the 25 main competencies of the Differentiated Entry-Level Competencies (DELC) for graduates from Associate Degree Nursing Programs in Texas. ORGANIZING FRAMEWORK The TVCC ADN Program Curriculum has an eclectic organizing framework. It was developed using the integrated nursing courses available in the Workforce Education Course Manual (WECM). The integrated courses are created based upon the belief that man has both physiological and psychosocial needs that must be met across the life span. The courses of the nursing curriculum follow the continuum of health care and are structured based on an organizational framework of primary, secondary, and tertiary prevention. The services related to primary prevention focus on health promotion and specific protection from disease or illness. Secondary prevention activities are directed toward early diagnosis and prompt treatment of health problems or illness. Nurses implement tertiary prevention or rehabilitative activities to assist clients to achieve the highest level of functioning following treatment of a health problem or illness. The Level I theory course emphasizes primary prevention including health promotion. The clinical course includes an assessment of a well elderly and a well child. Levels II and III focus on secondary prevention moving from commonly occurring problems to complex problems. The Level II clinical course emphasizes care of obstetrical and surgical patients and patients with other commonly occurring health problems. Level III clinical courses include nutritional teaching of a client with complex health care problem and care of clients with complex health care problems. Level IV focuses on tertiary prevention including long-term care and rehabilitation. The clinical course includes rotations in cardiac rehab, home health, long-term care, school nursing, dialysis and psychiatric care. After the introduction to concepts in the first semester, each subsequent semester contains units organized according to integrated systems across the life span. Within each unit, objectives are organized according to the steps of the nursing process as outlined in the Differentiated Entry Level Competencies for Graduates of Texas Nursing Programs. The program threads found throughout the program include nursing process, nursing roles, safety considerations, ethical/legal considerations including the Texas Nursing Practice Act (NPA), developmental considerations, cultural considerations and pharmacological considerations. 5 Nursing Process Nursing Roles Ethical/Legal, Safety, Developmental, Cultural, & Pharmacological Considerations Tertiary Prevention DEFINITIONS Primary prevention Primary prevention services are directed toward health promotion and protection from specific diseases. Care activities include immunizations and education related to fitness, nutrition, hygiene, and risk factors. Secondary prevention Secondary prevention services are directed toward early diagnosis and prompt treatment of health problems or illness. Care activities include actions designed to reduce severity of an illness or avoid complications and encompass screening, acute medical and surgical care, and nursing care provided at home. Tertiary prevention Tertiary prevention services are directed toward assisting the person to function at their highest level of wellness. Care activities include rehabilitation and long-term care, preventing further disability or reduced functioning. Caring Caring is the value of nursing in which there is high concern for human dignity. It includes forming relationships with individuals/families in compassionate, nurturing, protective, empathetic, nonjudgmental, open-minded and altruistic ways. Competency Competency is the quality or state of being functionally adequate, having the necessary knowledge, skills or attitudes. Nursing requires cognitive, technological, and cultural competence. Collaboration Collaboration is the act of two or more individuals working cooperatively to achieve a common goal. Nurses collaborate with individuals/families and the multidisciplinary health care team to assist in meeting health care needs and ensuring continuity and coordination of care. 6 Critical Thinking Critical thinking is purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation and inference, as well as explanation of the evidential, conceptual, methodological, criteriological or contextual considerations upon which that judgment is based. Nurses utilize the tools of critical thinking, including diagnostic reasoning, making clinical inferences, clinical decision-making and the nursing process. Community Community may refer to the particular place or region, in which the student/nurse lives, works, rests, prays, or seeks health care or a group of people with a common goal. Nurses provide communitybased health care services for individuals/families within a continuum of health care settings. Examples include community hospital care, home health care, occupational health care services, long-term care, school nursing services, rehabilitation services, clinic services, and physician office services. Associate degree nurses are also members of a professional community. They collaborate with various levels of nursing to address needs and concerns specific to the aspects of providing health care in collaboration with other disciplines. Cultural Sensitivity Cultural sensitivity involves recognizing the possibility of different meanings of behavior, looking objectively for cues that suggest the meaning, and validating the interpretation with the client. A foundation of cultural sensitivity is necessary for the nurse to provide culturally competent care. Client Advocacy As a client advocate, the nurse assists clients in expressing their rights whenever necessary and supports the client’s right to have health care that is consistent with the client’s values and beliefs. The nurse seeks to ensure that the client receives the best possible care and speaks for that person when the person is unable to speak for him or herself. Change Agent A change agent influences the direction of change and manages the change process. The nurse, as a change agent, is a proactive and reactive practitioner who acts to modify and improve current health care based on evidenced-based practice. Body Systems Body systems are the division of the human body into specific areas of human physiological and psychological functioning. Nursing Process The nursing process is a systematic, client-centered, goal-oriented method that directs the nurse and client to determine the need for nursing care through assessment, analysis, planning, implementation of the care, and evaluation of the effectiveness of the care provided. The purpose of the nursing process is to assist the nurse to manage the client’s care scientifically and competently while promoting, maintaining, or restoring health or supporting the client with a peaceful, dignified death. 7 Nursing Roles The nursing process is administered through the interrelated roles of nursing, which define the functions of the nurse. As a provider of patient-centered care, the nurse focuses care on the patient and not the disease or provider. The nurse utilizes critical thinking to implement the nursing process in a caring, competent, culturally sensitive manner. The role of the provider includes the use teaching/learning principles and practice within legal, ethical and regulatory parameters. As a patient safety advocate, the nurse promotes a safe environment for patients, maintains professional boundaries, and demonstrates knowledge about the Texas Nursing Practice Act and Board rules. As a member of the health care team, the nurse collaborates, communicates, delegates, supervises, refers, and functions within the nurse’s legal scope of practice. As a member of a profession, the nurse serves as a health care advocate, and assumes responsibility and accountability for one’s own competence and the quality of care provided. Safety Considerations Safety is the minimization of risk to patients and providers through both system effectiveness and individual performance. Safe nursing practice includes consideration of factors affecting safety, creating a culture of safety, recognizing adverse effects, effective use of technologies and strategies to support a safe environment for patients and providers, incorporation of the Joint Commission’s National Patient Safety Goals into patient care, and quality improvement processes. Ethical/Legal Considerations Ethics is the systematic, autonomous, critical inquiry of inner values that direct decisions regarding right and wrong as they related to conduct. Ethics involves the promotion of good and the avoidance of harm to clients under nursing care. Laws affecting nursing practice, including the Texas Nursing Practice Act, are standards or rules of conduct established and enforced by the government that are intended to protect the rights of the public and enable nurses to conduct themselves in a manner that is consistent with their personal moral code and professional role responsibilities. Developmental Considerations The developmental process is an orderly, predictable, continuous, life-long progression of either an individual or family through definable stages beginning at conception and ending with death. Development is an outcome of the individual’s or family’s response to a variety of intrinsic and extrinsic factors: biological, chronological, psychological, social, environments, life experiences, and state of health. Nursing practice focuses on identification of the states of the basic life cycle to promote factors that permit attainment of the client’s optimal potential. Cultural Considerations Nursing seeks to understand each client’s unique perspective in order to provide care that enhances his/her individual health and well-being. Focusing on the differences and similarities among cultures is the framework needed to provide culturally competent nursing care, especially in regard to caring, health and illness. Pharmacological Considerations Medication administration includes the knowledge of medication classification, actions and interactions, side/adverse effects, nursing implications, and safe administration practices. It is fundamental and imperative for the nurse to competently and safely administer medications and assess the effects of the medication on the client’s health. This knowledge incorporates the physiological, psychological, and sociological effects of medication administration on clients. w:\syllabus\handbook\philosophy.doc Reviewed 03/10 8