The conceptual framework of CCRI's Nursing Program is its central focus on the dynamic process of caring actions within the context of the nurse-patient relationship. This relationship is defined as a dynamic one, between the nurse and the patient, for the purpose of helping the patient. The nurse-patient relationship is central to every nursing activity. It focuses on the patient and is therapeutic, purposeful, and goal directed in nature. The nurse's unique position in the provision of nursing care allows for the promotion of patient advocacy. These major components along with supporting concepts provide direction and structure for developing the program of learning in nursing.
The nurse-patient relationship is the foundation for caring practice. Caring is a force for protecting and enhancing patient dignity. The nurse affirms patients as persons rather than objects, and assists them in making choices, and finding meaning in their illness experience. Caring is a morally responsible action that takes place within the nurse-patient relationship. This caring action has its basis in the nurse’s responsibility and accountability, to give safe and competent care when the patient is unable to care for themselves. Nurse caring differs from other caring professions in that a nurse’s time with patients spans a twenty-four hour period, involves the use of touch, and includes being in another’s intimate space. Examples of caring action include but are not limited to, the physical care of the body that promotes comfort and healing, health and medication teaching, listening, and psychological and spiritual support.
Caring about others begins with caring about self and other nurses. Caring is learned by experiencing caring practices among faculty and students, which cultivates sensitivity to self and others. The student learns the basic constructs of caring including but not limited to comfort, compassion, concern, empathy, helping behaviors, nurturance, support, involvement, and sharing. A second dimension of caring involves the actual "caring for". Caring for refers to providing for or being responsible for another in a competent manner.
The nursing process is a critical thinking tool that provides the structure for caring action. The patient/family needs are assessed according to Maslow's hierarchy of needs. The structure of the nursing process, Maslow's hierarchy of needs and Gordon’s Functional Health Patterns, form the standards by which critical thinking skills are developed by the student throughout the curriculum.
The assessment phase of the Nursing Process includes the use of multiple sources to collect pertinent data and is related to Gordon's Functional Health Patterns. This database is next analyzed for the purpose of identifying patient needs and their hierarchy according to Maslow. From this analysis, the North American Nursing Diagnosis Association's (NANDA International) nursing diagnoses are established. Based on each nursing diagnosis, Nursing Outcomes Classification (NOC) and specific patient outcomes are identified, and an individualized plan of Nursing Intervention Classification (NIC) is developed to meet patient needs. The implementation step involves the actual carrying out, or administering of the nursing orders, or collaborative actions based on priorities of care. Evaluation of patient outcomes based on identified goals as the criteria for evaluation, help the nurse to judge the success of nursing care. Based on the evaluative process, the nurse becomes aware of a need for revision and modification of the plan of care. Thus, the nursing process is viewed as dynamic and continuous.
The nursing arts and scientific knowledge, which are consistent threads throughout the curriculum, serve as a standard for critical thinking throughout course content. Criteria necessary to promote the nurse-patient relationship include communication and interpersonal skills, which convey a respect and a professional responsibility for all.
The interplay of man, health, and environment serves as the context in which the nurse-patient relationship exists. Man is viewed as a human being who is a unique biopsychosocial, cultural, and spiritual individual, who functions as a whole in response to internal and external cues in the physical and social environment. The concept of health is considered a dynamic state that includes all aspects of one's life: physical well-being, social interaction, emotional capacity, and spiritual well-being. Health promotion is a valued activity within the nursing role, and includes the related concepts of wellness, primary, secondary and tertiary prevention. To achieve this end, the student is encouraged to be a role model of healthy behaviors, and to teach health care strategies.
Health promotion concerns are those activities directed towards maintaining or enhancing the health and well being of individuals and their families. The student learns the role of patient advocate as he/she provides information needed to make health care decisions and then supports the patient in that decision. The student learns and teaches health practices that promote and enhance optimum functional levels of wellness. Such practices include, but are not limited to, nutrition, diet, exercise, drug therapy and complementary therapies.
The environment consists of two major components, the practice milieu, and those internal and external factors that the patient brings to the health care setting. The concept of environment is viewed as external to the person directly affecting health and well-being. Other externals include health care environment structures such as inpatient and outpatient settings, acute, sub-acute, long-term care, home and community care.
The culture of the practice environment, whether inpatient, outpatient or home care, is very complex. This complexity creates the need for collaboration between health care disciplines and services. Today's market driven health care system creates tension in the practice environment between our professional philosophy and the reality of cost containment and changing health policies. Multidisciplinary approaches are required for the planning and management of patient's needs within a cost-effective framework. In the process of educating future nurses, it is essential for the student to grasp how the impact of these external factors affects health care outcomes.
Together, the nurse with the patient, create a health promoting and healing environment. The nurse as presence, being there and with another in time of need applies critical thinking skills to bridge the gap between the technological aspects of care and the human responses to illness and disease. The nurse’s unique position in relation to the patient and family allows for facilitation of healing. In addition, the healing environment encompasses self-activity of the patient that incorporates complementary strategies to promote wellness. Healing practices are adapted to patients’ needs and particular health care settings. The support of family members and significant others is critical to the healing environment. Cultural diversity impacts the healing environment and nursing students learn to appreciate and respect this diversity.
The profession of nursing has a set of values that act as a standard to guide nursing behavior. The profession expects its members to know, understand, and internalize these values. The interaction of personal, professional and patient values enter into the process of decision making. In an effort to achieve sound ethical and legal decision-making, the faculty directs the student toward the formulation of professional values. Within this framework, the faculty emphasizes that students are directly accountable for their behavior.