School of Nursing Queens University

Bachelor of Nursing Science Program Curriculum Document

Nov 2004 Revised July 2012

7/18/2012 8:10 AM

TABLE OF CONTENTS
INTRODUCTION PHILOSOPHY I. II. PROGRAM GOALS

PAGE
3 3 4 4 5 5 11 11 14 16

CURRICULAR CONCEPTS: Figure 1: Foundational Curricular Concepts with Sub-concepts Definitions of Concepts CURRICULAR CONCEPT MAP Legend Table 1: Curriculum Concept map References

III.

IV.

INTRODUCTION
The Undergraduate Curriculum Committee of the School of Nursing prepared this document in order for students and faculty to be able to clearly identify how our program philosophy, goals, curriculum concepts and sub-concepts, curriculum content and the College of Nurses of Ontario (CNO) competencies are addressed throughout our curriculum. Philosophy The philosophy of Queens University School of Nursing is consistent with the mission and vision of Queens University, www.queensu.ca and reflects the nursing faculty belief that exemplary nursing practice is built upon the foundational blocks of the sciences and arts. The purpose of the nursing program is to educate individuals to competently address the health needs of individuals, families, and communities in a variety of environments. Central to the program are the five core concepts of quality, health, client, environment and transitions. Nursing is a dynamic profession requiring critical and reflective thinking based on current scientific rationale, as well as humanistic perspectives. Partnering with individuals, families, and communities, nurses assist their clients through various life transitions, using sound decision-making and therapeutic communication in their interactions. Competent care requires not only an understanding of bio-psychosocial processes, but also the socio-environmental and cultural contexts that affect clients, families, and communities. We believe these approaches to academic excellence prepare practitioners to make caring connections and allow learners to transition integrating sciences, humanities, and evidence-based health care into their professional roles as nurses and life-long learners. We believe students should have the opportunity to learn interprofessionally with, from, and about each other. Students learn best from role models who foster caring and inquiry into human transitions from theoretical, practice, and research perspectives. The philosophy of the Queens University, Bachelor of Nursing Science program is reflected in our understanding of core foundational concepts underpinning the curriculum. Five core nursing concepts with related sub-concepts provide the foundation for the curriculum of the B.N.Sc Program (see Figure 1). The curriculum concepts represent key components of the program goals and are layered within and across the program in a curriculum concept map which serves as a framework to situate core content in a deliberate manner. The threading of the concepts in the curriculum concept map demonstrates how students move progressively towards the program goals (see Table 1).

l. Program Goals
The program prepares graduates to: Provide safe competent and culturally sensitive nursing service in response to changing needs of society and according to prevailing legal and ethical standards Use critical thinking, problem-solving, and scientific inquiry in the practice of nursing and in monitoring and ensuring quality of health care practices Communicate effectively in relationships with clients and health professionals Use nursing knowledge and skills in partnership with individuals and families and other health care professionals to maintain and promote health and well-being and provide care and support during illness Use population-based and intersectoral approaches to assess, protect, and promote the health of communities Appreciate how specific environments and socio-political conditions affect health behaviour, professional practice and public policy Apply leadership and managerial abilities and political skills to attain quality care for client and quality of work-life for co-workers Engage in self-directed learning, reflective and evidence-based practice

ll. Curriculum Concepts

The five major nursing foundational concepts are: quality, health, client, environment, and transitions. Each concept has related sub-concepts which are illustrated in Figure 1. Definitions of the major concepts and sub concepts follow. Nursing is both an art and a science. It is a preventative, educational, restorative and supportive health-related discipline/service/activity. Nursing is provided in a caring and competent* manner for the purpose of enhancing an individuals quality of life, and when life can no longer be sustained, supporting the dying person. Respect for the dignity, worth, autonomy and individuality of each human being is inherent in all aspects of nursing. Nursing is provided in any setting where individuals, families, groups, and communities are in need of the benefits of nursing. Nurses work both independently and collaboratively with other health care providers. Nurses meet the ethical and legal requirements of their profession. Nurses practice life-long learning. * professional competence is the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served. (Epstein & Hundert, 2006)

Quality
Caring Evidence-Informed DecisionMaking Evidence-Informed Practice Interprofessional Collaborative Practice Leadership

Transitions
Developmental Health and Illness Organizational Situational

Health
Disease Prevention Health Promotion Health Protection Rehabilitation Patient Safety

Undergraduate Curriculum
Client

Environment
Cultural Competence Political Practice Setting

Community/Population Determinants of Health Individuals/ Family Therapeutic Relationships

Queens University School of Nursing Foundational Curriculum Concepts

Figure 1. Foundational Curricular Concepts with Sub-concepts

DEFINITIONS OF CONCEPTS QUALITY Quality: Qualityconsistsofthedegreetowhichhealthservicesforindividualsandpopulations increasethelikelihoodofdesiredhealthoutcomes(qualityprinciples),areconsistent withcurrentprofessionalknowledge(professionalpractitionerskill),andmeetthe expectationsofhealthcareusers(themarketplace).(Burhans&Alligood,2010;Buttell, Hendler&Daley,2008) Caring Caring is expressed through an interpersonal interaction between a nurse and client. The nurse identifies in collaboration with the client their needs for self-maintenance or selfregulation and assists the client to meet these needs. Nursing-specific interventions are

6 applied to act for, guide, support and influence environmental conditions to promote the personal development and health of the client. (Finfgeld-Connett, 2008; Morse, J. 1990).

Evidence-Informed Decision Making Evidence-informed decision making is a continuous interactive process involving the explicit, conscientious and judicious consideration of the best available evidence to provide care. It is essential to optimize outcomes for individual clients, promote healthy communities and populations, improve clinical practice, achieve cost-effective nursing care and ensure accountability and transparency in decision-making within the health care system. CNA (2010). Canadian Nurses Association Position Statement: Evidenceinformed decision making and nursing practice. Critical Thinking Practicing the cognitive skills of analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting and transforming knowledge. (Martinez de Castillo, 2010). Creativity A meta-cognitive process that: 1) generates novel and useful associations, attributes, elements, images, abstract relations, or sets of operations, and 2) better solves problems, produces a plan or results in a pattern, structure or product not clearly present before. (Fasnacht, 2003).

Evidence-informed practice Nursing practice is based on various types of evidence, including experimental and nonexperimental research, expert opinion, and historical and experiential knowledge, shaped by theories, values, client choice, clinical judgment, ethics, legislation, and work environments. Evidence-based decision-making is a continuous interactive process involving the explicit, conscientious and judicious consideration of the best available evidence to provide care. (Canadian Nurses Association, 2002b, 2010).

Interprofessional Collaborative Practice (IPCP) is designed to promote the active participation of each discipline in patient care. It enhances patient and family-centred goals and values, provides mechanisms for continuous communication among caregivers, optimizes staff participation in clinical decision making within and across disciplines and fosters respect for disciplinary contributions of all professionals (Oandasan, 2006). Partnerships: Refers to situations in which the nurse works with the client and other members of the health care team to achieve specific health outcomes for the client. Partnership implies consensus building in the determination of these outcomes. Interprofessional collaborative practice occurs when different health care professions provide comprehensive services by working with patients, families and communities to

7 deliver high quality of care across the settings. (WHO Framework for action on interprofessional education and collaborative practice. 2010) http://

Leadership Process of persuading and influencing others toward a goal, through mostly non-coercive means; typically composted of a wide variety of roles. (Marquis & Huston, 2006).

HEALTH Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. It involves the ability to achieve ones potential and respond positively to the challenges of the environment. Health is seen as a resource for everyday life not the objective of living. Disease Prevention Disease prevention covers measures not only to prevent the occurrence of disease, such as risk factor reduction, but to arrest its progress and reduce its consequences once established. Primary prevention is directed towards preventing the initial occurrence of a disorder. Secondary prevention seeks to arrest or retard existing disease and its effects through early detection and appropriate treatment: tertiary prevention reduces the occurrence of relapses and the establishment of chronic conditions through, for example, effective rehabilitation. Disease prevention is sometimes used as a complementary term alongside health promotion. Although there is frequent overlap between the content and strategies, disease prevention is defined separately. Disease prevention in this context is considered to be action which usually emanates from the health sector, dealing with individuals and populations identified as exhibiting identifiable risk factors, often associated with different risk behaviours. (WHO, 1998, p.4)

Health Promotion Health promotion is the process of enabling people to increase control over, and to improve their health. Health promotion represents a comprehensive social and political process. It not only embraces actions directed at strengthening the skills and capabilities of individuals but also action directed towards changing social, environmental and economic conditions so as to alleviate their impact on public and individual health. World Health Organization 1998, Health Promotion Glossary (Online). Available: www.who.int/hpr/arcive/docs/glossary.pdf, August 1, 2006

Health Protection Those public health activities intended to protect individuals, groups, and populations from infectious diseases, environmental hazards such as chemical contamination, and from radiation. (Health Canada, 2002).

Rehabilitation of people with functional limitations or disabilities is a process aimed at enabling them to reach and maintain their optimal physical sensory, intellectual, psychological and social functional levels. Rehabilitation provides people with the tools and resources they need to attain independence and self determination. Adapted from WHO 2009a. Patient Safety Patient safety is the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. An acceptable minimum refers to the collective notions of given current knowledge, resources available and the context in which care was delivered weighed against the risk of non-treatment or other treatment. (P.15). (World Health Organization, 2009b).

Is the reduction of risk of unnecessary harm associated with health care to an acceptable minimum. An acceptable minimum refers to the collective notions of given current knowledge, resources available, and the context in which care was delivered weighed against the risk of non-treatment or other treatment. (Canadian Patient Safety Institute, 2011).

CLIENT The client/patient/person is the focus of nurses care and with whom the nurse is engaged in a professional relationship. The client may be an individual, family group, population or community. An individual is a single human being who may be a representative of any stage throughout the lifespan, of any culture, and who is unique and inherently worthy. Families consist of individuals who are united by ancestry or choice. Groups and populations share common purposes or health needs. A community is a group of people living in one place, bound by common characteristics and having common health needs. The client/patient/person is in partnership with the health care team in consensual determination of desired health outcomes.

9 Community/Population: An organized group of persons bound together by ties of social, ethnic, cultural, occupational origin or geographic location and sharing common characteristics/interests which bind them together, or having common health needs. The term community (when used to describe a client) does not mean providing care to an individual in the community. Nursing practice aimed at the community as a client involves assisting communities to identify, articulate and successfully manage their health concerns. It is concerned primarily with care that is continuing, rather than episodic. The focus is on the collective or common good, instead of an individuals health. Population refers to all people sharing a common health issue, problem or characteristic. These people may or may not come together as a group (CNA, 2004a). Determinants of Health Social determinants of health are the economic and social conditions that influence the health of individuals, communities and jurisdictions as a whole. These determinants of health in combination influence health status.CNA (2005). Social determinants of health and nursing: A summary of the issues. Individuals: Single human beings throughout the lifespan, including neonates (birth to 28 days), infants (29 days to 1 year), children (1 year to 12 years), adolescents (13 to 18 years), adults (19-65 years) and elderly adults (65 years and older). Family: People united by a common ancestry (biological families), acquisition (marriage or contract) or choice, and their friends. Therapeutic Relationship: a relationship that is professional and therapeutic and ensures the clients needs are first and foremost. The relationship is based on trust, respect and intimacy, and requires the appropriate use of the power inherent in the care providers role. The professional relationship between registered nurses and their clients is based on the recognition that clients (or their alternative decision makers) are in the best position to make decisions about their own lives when they are active and informed participants in the decision making process. (College of Nurses of Ontario, 2006; CRNCBC, 2006c). ENVIRONMENT Environment surrounds individuals wherever they go and whatever they do; is composed of physical, political, economic, sociocultural, and biological components. (Shookner, Scott & Vollman, 2008). (p. 85). Environment refers to the external elements that affect the person; internal and external conditions that influence the organism; significant others with whom the person interacts; and an open system with boundaries that permit the exchange of matter, energy, and information with human beings. (McEwen & Wills, 2007).

Cultural Competence. Includes, but is not restricted to age or generation;Cultural competence is the application of knowledge, skill, attitudes and personal attributes required by nurses to provide appropriate care and services in relation to

10 cultural characteristics of their clients. Cultural competence includes valuing diversity, knowing about cultural mores and traditions of the populations being served and being sensitive to these while providing care. (CNA, 2004). Promoting Culturally Competent Care. Political Nurses speak to and advocate for health issues to the public, governments and other organizations through political action, representation and leadership. (CNA, 2011) Practice Setting Quality practice settings create and maintain characteristics that support professional nursing practice, including appropriate professional preparation, suitable conditions for nursing practice, respect for nurses as responsible decision makers and recognition of professional expertise. (College of Nurses, 2009, Standard of Care: Ethics, pg 4.)

TRANSITIONS Transitions Transition in health and illness are a central substantive domain in the discipline of nursing. Most nursing interactions occur due to disequilibrium or the risk of disequilibrium caused by real, potential or perceived changes to well-being. Therapeutic nursing interventions support the client experiencing transitions and reduce associated risks. This field is concerned with the nature, impact, outcome, and management of the following types of health and illness related transitions: developmental transitions such as birth, death, and the passage to old age; illness transitions such as the passage to chronic illness or the experience of a health crises; and finally, transitions through the health care environment. (School of Nursing, Queens University, 2006). Developmental Transitions Changes within an individual or a family related to the lifespan of the person in the case of an individual or to family members in the case of a family. Adapted from Meleis, A (1994).

Health and Illness Transitions Changes involved in moving from wellness to illness or from illness to wellness. Adapted from Meleis, A (1994). Organizational Transitions Changes within the organizational environment. Adapted from Meleis, A (1994).

Situational Transitions

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Changes in the internal or external environment which affect the life of an individual, family, community or population. Adapted from Meleis, A (1994).

lll. Curriculum Concept Map

C = Clinical Course T = Theory/Classroom Course

NURSING A. QUALITY Caring YEAR ONE 101- T 100-T 108-C YEAR TWO 202-C 206-C 207-C 209-T 207-C 202T,C 205-T 206-C 209-T 205-T 206-C 207-C 209-T 324-T 207-C YEAR THREE 371-C 345-C 370-T 325-T 323-T 371-C 345-C 305-T 370-T 325-T 323-T 370-T 371-C 345-C 305-T 325-T 371-C 345-C YEAR FOUR 401-T 404-T 405-C 492-C 401-T 403-T 404-T 405-C 414-T 492-C 401-T 403-T 404-T 405-C 414-T 492-C 401-T 414-T 492-C

Evidence-Informed Decision Making

101-T 100-T 108-T

Evidence- informed practice

101-T 100-T

Interprofessional collaborative practice

101-T 108-T

Leadership

371-C 345-C

401-T 414-T 492-C

12

Curriculum Concept Map (continued) B. HEALTH Disease Prevention YEAR ONE 100-T 108-T YEAR TWO 202-T 205-T 206-C 209-T 202-T,C 209-T 205-T YEAR THREE 305-T 325-T YEAR FOUR 404-T 405-C 492-C

Health Promotion

100-T 108-T

370-T 325-T 371-C 345-C 370-T 325-T

404-T 405-C 492-C

Health Protection

100-T 108-T

206-C 209-T

404-T 405-C 492-C

Rehabilitation

108-T

205-T 207-C 209-T

305-T 325-T 371-C 345-C 305-T 325-T 345-C 370-T 371-C

403-T 492-C

Patient Safety

108

202-T 205-T 206-C 207-C 209-T

403-T 405-C 414-T 401-T 492-C

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Curriculum Concept Map- Health (continued)

YEAR ONE Community/Population 108-T

C. CLIENT

YEAR TWO 209-T

YEAR THREE 325-T

Determinants of Health

108-T

202-T 209-T

325-T

Individual & Family

101-T, C 108-T

Therapeutic Relationships

101-T,C 100-T 108-T

202-T 205-T 206-C 207-C 209-T 202-T 206-C 209-T 207-C

305-T 325-T 345-C 370-T 371-C 371-C 345-C 370-T 325-T

YEAR FOUR 401-T 404-T 405-C 492-C 401-T 404-T 405-C 492-C 403-T 492-C

404-T 405-C 414-T 492-C

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Curriculum Concept Map- Health (continued) D. ENVIRONMENT Cultural Competence YEAR ONE 108-T YEAR TWO 205-T 206-C 207-C 209-T 209-T YEAR THREE 370-T 325-T 371-C 345-C 370-T 325-T 371-C 345-C 325-T 345-C 371-C YEAR FOUR 401-T 404-T 405-C 414-T 492-C 404-T 405-C 401-T 414-T 492-C 401-T 404-T 405-C 414-T 492-C

Political

101-T 108-T

Practice Settings

101-T

207-C

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Curriculum Concept Map (continued)

E. TRANSITIONS Developmental

YEAR ONE

YEAR TWO

YEAR THREE

YEAR FOUR

100-T

Health/ Illness

108-T

202-T 207-C 205-T 206-C 209-T 202-T 205-T 207-C 209-T 209-T

305-T 325-T 370-T 371-C 345-C 305-T 325-T 370-T 371-C 345-C

401-T 492- C

Organizational

100-T

401-T 403-T 492- C 404-T 405-T 401-T 414-T 492- C

Situational

206-C 207-C 209-T

371-C 345-C 370-C 325-T

401-T 492-T

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