Department of Nursing Statement of Understanding
Thank you for your interest in becoming a part of the Carroll College Nursing Program. The decision to apply to the nursing program is one that you have already spent time thinking about, talking about, and planning for. As you complete your application and make the commitment to pursue your nursing degree at Carroll College, we would like to offer some additional information about what it means to be a baccalaureate prepared nurse.
Some of you may have spent many hours researching the differences between baccalaureate education and other forms of nursing education and others may have spent little time contemplating the differences. You may have selected Carroll College for a variety of other good reasons such as its reputation, size, location, and Catholic tradition. All of these are good reasons to have begun your journey here at Carroll, but it is also important for you to understand and commit to what it means to be a Carroll College baccalaureate prepared nurse. This commitment will help you not only be motivated to learn, but to also trust the faculty and the standards and curriculum set for this program to guide you in your education.
We believe it is important for you to consider how baccalaureate nursing education programs differ from associate degree programs. This decision is important for your future and we want to inform our nursing applicants about what our program has to offer so that the admitted students have knowledge about and can commit to this level of nursing education.
The Carroll College Nursing program is accredited by the Commission on Collegiate Nursing Education of the American Association of Colleges of Nursing (AACN-CCNE). The standards of education in this accredited baccalaureate nursing program are set forth by the Commission on Collegiate Nursing Education (CCNE) in a document entitled The Essentials: Core Competencies for Professional Nursing Education (AACN, 20021). Some discussion of the Domains essential to Nursing Practice with presentation of an unfolding example will help you understand what they mean and how they are going to shape your nursing education at Carroll College.
Domain 1: Knowledge for Nursing Practice
Integration, translation, and application of established and evolving disciplinary nursing knowledge and ways of knowing, as well as knowledge from other disciplines, including a foundation in liberal arts and natural and social sciences. This distinguishes the practice of professional nursing and forms the basis for clinical judgment and innovation in nursing practice.
Many nursing students wonder why courses in literature, history, philosophy or writing are required as part of a baccalaureate nursing program. Professional baccalaureate prepared nurses utilize the knowledge they gain from these important Core and support courses to think about nursing and health care issues from a broad perspective. Exposure to a wide variety of disciplines, professors, students and community members either has or will help you develop a basic understanding of global and national diversity issues and develop both critical thinking and communication skills.
Example: You are a nurse working on a medical surgical unit. There has been an increase in the population of migrant workers in your community and you have assessed that your hospital does not have guidelines and policies in place to address the health care needs and cultural beliefs and values of these patients. You utilize your oral and written communication skills as a part of the hospital task force for policies and procedures to address these issues. You also use concepts from sociology and psychology to assess the health perspectives of the migrant population.
Domain 2: Person-Centered Care
Person-centered care focuses on the individual within multiple complicated contexts, including family and/or important others. Person-centered care is holistic, individualized, just, respectful, compassionate, coordinated, evidence-based, and developmentally appropriate. Person-centered care builds on a scientific body of knowledge that guides nursing practice regardless of specialty or functional area.
The baccalaureate prepared nurse views the patient in the context of their life story and their community. They examine the factors that influence the patient’s current state of health, including social determinants of health, their cultural practices, and how the nurse can intervene to ensure that the patient has the resources and support to improve their health and quality of life. This does not mean that the hospital nurse is independently responsible to provide for the health promotion and prevention needs of the patient. Instead, the nurse recognizes the importance of prevention and promotion efforts for the overall health and well being of the individual as well as the community where the patient lives.
Example: Your hospital task force proposes a policy requiring that all new employees must complete an eight-hour cultural sensitivity class on caring for migrant workers and their families at your hospital. With this new education and knowledge, you know how to better anticipate the questions and assessments that might help you to identify the unique needs of the individual patients you encounter that are part of this migrant population. Having knowledge of the larger migrant community, you are able to ask your patient about potential cultural differences, needs, expectations, or preferences. You are able to recognize that, while part of a larger community, each patient is a unique individual.
Domain 3: Population Health
Population health spans the healthcare delivery continuum from public health prevention to disease management of populations and describes collaborative activities with both traditional and non-traditional partnerships from affected communities, public health, industry, academia, health care, local government entities, and others for the improvement of equitable population health outcomes.
While nurses are charged with focusing care on the individual, as described in Domain 2, they are also a contributing member of a larger, more global, healthcare team. While it is certainly true that many nurses choose to practice their profession in areas where medical care is delivered, such as a hospital, some nurses practice in areas that focus on prevention and health promotion, working with communities as a whole as their patient. It is important to understand that all nurses focus on prevention and health promotion, regardless of their practice setting. This Domain is closely related to Domain 6 as nurses must be able to refer patients into the community to appropriate professionals, including the community health nurse whose specialty is prevention and health promotion.
Example: Your task force invites the local public health nurse and representatives of the migrant community to attend your task force meetings to develop systems for referral of migrant workers and to gain input into the issues and needs of the migrant worker population that need to be addressed within the hospital.
Domain 4: Scholarship for Nursing Discipline
The generation, synthesis, translation, application, and dissemination of nursing knowledge to improve health and transform health care.
Since the time of Florence Nightingale, the nursing profession has been committed to developing nursing practice and interventions based on sound science and inquiry. As the body of nursing knowledge expands, it is important that baccalaureate prepared nurses critique research and also integrate research into practice. Evidence-based practice in nursing incorporates the use of evidence, professional expertise, knowledge of community, and patient choices to design high-quality health care.
Example: While you serve on your hospital’s task force to improve care for the migrant workers in your community, you review the nursing research on providing culturally sensitive care to migrant populations. You also use your communication skills to interview members of the migrant community about their concerns, needs and preferences when they are in the hospital. You invite members of the migrant community to join your task force to improve care for migrant workers in the hospital.
Domain 5: Quality and Safety
Employment of established and emerging principles of safety and improvement science. Quality and safety, as core values of nursing practice, enhance quality and minimize risk of harm to patients and providers through both system effectiveness and individual performance.
Nurses are integral members of the healthcare team who advocate for quality and safety of patient care and for the overall nursing profession. Each team member must be accountable for the quality, safety and cost of healthcare. Nurses will be required to not only understand quality improvement processes but also participate and contribute to the program used by their organization/employer. Nurses are involved in patient care 24 hours a day and at all levels of care and therefore, nurses' involvement in risk management is vital to the success of an organization’s risk management program. As healthcare evolves, nurses will also be part of changes in efficiency and ultimately the cost of healthcare delivery and utilization.
Example: In order to address and serve the health and safety needs of the migrant workers, your task force engages in community assessments, partnership building, and advocacy. Through the assessment, the task force recognizes that local migrant workers need more social support to address substandard housing, food insecurity, language barriers, and lack of access to health insurance. By further understanding that many workers who are undocumented may not qualify for certain health insurance programs, the task force encourages the hospital to partner with local organizations such as the Montana Migrant Council to optimize access to healthcare at all levels of prevention. Quality and safety within the healthcare system are both improved when the social determinants of health are recognized and addressed in this vulnerable population.
Domain 6: Interprofessional Partnerships
Intentional collaboration across professions and with care team members, patients, families, communities, and other stakeholders to optimize care, enhance the healthcare experience, and strengthen outcomes.
In this Domain, we recognize that nurses must also develop their understanding of the services provided by other professions involved in health care. We must be able to identify common areas of health practice and intervention and also where boundaries between disciplines are firm. In order to understand the roles of other disciplines and the services they provide, you will be exposed to a wide variety of clinical settings that employ health professionals from many disciplines. In order to collaborate effectively, the nurse must be able to describe the role and scope of practice of other disciplines, identify common language terms and utilize appropriate communication methods incorporating mandates for privacy and confidentiality.
Example: During your task force meetings, your group identifies key people in the community to assist with language/culture interpretation and identify migrant healers and health practitioners who can be utilized as consultants in the patient care setting. Your task force also identifies how the mandates related to confidentiality and privacy will be maintained when consulting with members of the community who are not employees of the hospital.
Domain 7: Systems-Based Practice
Responding to and leading within complex systems of health care. Nurses effectively and proactively coordinate resources to provide safe, quality, equitable care to diverse populations.
This outcome addresses not only the hands-on aspects of holistic patient centered care but also the roles of the nurse within the larger health care system. As a baccalaureate prepared nurse, you will not only be assessing and delivering care but you will be developing guidelines for delegation, teaching others how to give care including other nurses and family members. In order for nurses to deliver high quality and safe care to clients, they must have an understanding of how policies such as reimbursement for health care and how national, state, and local laws and regulations impact what we can and must do. The Affordable Care Act, future changes in immigration laws, and demographic shifts in our country and world will directly and indirectly impact health care and nursing. Because of these changes, nurses will need to be informed about processes to change laws and regulations. They will need to be involved with decisions at the institutional, local, state and national levels that impact the policies and laws that impact care.
It will not be enough that you know what to do, you will also have to be able to identify creative solutions to solving problems. For instance, you may need to be able to adapt principles of safe and effective care learned in settings where you have adequate resources and support personnel to the delivery of health care in third world countries and disaster scenes. Being able to incorporate cultural practices and folk remedies into your understanding of nursing intervention would require you to embrace the liberal arts and incorporate the learning from the many Ccore classes that you have and will continue to integrate into your role of the professional baccalaureate prepared nurse.
Example: Your task force will recommend that a Migrant Family Welcoming Center be built in the former hospital library space. Included in this center will be toys, games, and reading materials in Spanish. There will be a kitchenette available for food preparation. There will be resources for traditional healing. The task force will also be charged with ongoing continuing education which will be required of all direct care hospital staff. In addition, your task force composes a letter of support to your state legislature for a health law that would increase funding for health care for children of migrant workers.
Domain 8: Informatics and Healthcare Technologies
Information, communication technologies, informatics processes are used to provide care, gather data, form information to drive decision making, and support professionals as they expand knowledge and wisdom for practice. Informatics processes and technologies are used to manage and improve the delivery of safe, high-quality, and efficient healthcare services in accordance with best practice and professional and regulatory standards.
Our health care system has become increasingly dependent upon information management systems and patient care technologies. Nurses need knowledge of electronic health care records, point of care devices, remote care delivery systems such as telehealth and a multitude of other technologies. The nursing role includes not only knowing how to use these technologies but also understanding how this technology can be best used to deliver health care services.
Example: As a part of the hospital task force for policies and procedures, nurses have identified that many of their migrant patients do not speak English and that many of the hospital nursing staff do not speak Spanish. As part of the task force responsibilities, it is decided that they will research how Skype and/or other communication technologies can be used at the bedside to communicate with non-English speaking clients.
Domain 9: Professionalism
Formation and cultivation of a sustainable professional nursing identity, accountability, perspective, collaborative disposition, and comportment that reflects nursing’s characteristics and values.
As professional, baccalaureate prepared nurses, we must commit to treating all people with respect. This also includes patient advocacy, which means we speak respectfully to and about our patients, our colleagues and our communities. This Domain may well be one of the most difficult to teach and learn. Few students have ever challenged whether or not this Domain is important but the ability to consistently demonstrate this Domain in the real world is challenging. As students of nursing, your core values will be challenged by the care of some populations. You must be able to “practice with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.”(ANA, 2015, Code of Ethics, Provision 1). The exposure to people from all walks of life and people with a wide range of cognitive abilities will challenge your caring and altruistic motives. Learning how to be compassionate, caring, and professional when we are in the midst of caring for others who are in despair and pain can be personally and professionally challenging. Nurses must first recognize their own values, identify their own stressors to maintain professionalism, and be willing to develop a personal plan to maintain and nurture their caring abilities.
Example: The task force will develop a recommendation to administration for a nursing council whose role is to support nurses in caring for patients who are combative or hostile. This committee will be charged with continuing education on the ANA Code of Ethics and providing support and encouragement for nurses experiencing high levels of stress.
Domain 10: Personal, Professional, and Leadership Development
Participation in activities and self-reflection that foster personal health, resilience, and well-being, lifelong learning, and support the acquisition of nursing expertise and assertion of leadership.
While at Carroll College, you will take courses in leadership and management and you will also focus on patient safety and quality of care in all of your nursing classes. Thus, it is not enough to just know HOW to perform a procedure. As a nurse, your role involves critiquing the quality and safety of not only the care you give but the care given by others under your supervision. You will learn to question existing practices with safety and quality in mind and you will use your knowledge of organizational structures as well as your leadership skills to communicate your concerns to your fellow nurses and organizational leaders.
Example: Because you have developed your skills in clear and respectful communication, you can share with your peers and also with your supervisors your concerns about hospital policies and guidelines for working with the migrant workers. As a nurse, you recognize that direct and respectful communication is one of the strategies to maintain a healthy work environment. All nurses are responsible for fostering work environments based on civility.
Hopefully, from the above descriptions and examples, you understand that a Carroll College baccalaureate nursing education includes much more than hands-on skills and tasks done with patients. Because you will be able to critically think, communicate, and appreciate patients as holistic beings and because you will have skills to envision the future, you will be able to be a leader in the ever-evolving health care system of the future.